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PREVENTION "80

Prevention '80 U.S. Department of Health and Human Services Public Health Service Office of Disease Prevention and Health Promotion DHHS (PHS) Publication No. 81-50157

Preface "The health o! the American people has never been better." Healthy People Progress toward better health for Americans has been substantial in recent years. CertainIy the data give us cause for encouragement. Dramatic declines in the incidence of certain ~nfectious diseases have been joined by impressive gains in infant survival, and, ~pecially in the la.~t decade, surprising reductions in death rates from heart disease and stroke. Our sueeesses in preventing disease and di~abilit y in this country have led to a growing sense of optimism about the potential for future gains. Moreover, development of our national preven- tion strategy to enhance the prospect of those gains has taken form over the last decade. A number of prominent milestones are notable for their contribution to the definition of priorities and objectives. • President's Committee on Health Education, I971 • Preventive Medicine Task Forces of the Fogarty Center and the American College of Preventive Medicine, 1975 • Department of Health, Education and Welfare Task Force on Disease Prevention and Health Promotion, 1978 • The Surgeon General's Report on Health Promotion and Disease Prevention, Healthy People, 1979 • Promoting Health/Preventing Disease: Objectives for the Nation, 1980 With the specification of the measurable goals and objectives for 1990 contained in Healthy People and Objectives for the Nation, our emerg- ing concepttta] "roadmap" offers a clear charge. The task is now to marshal the collective resources of public agencies arid private organizations and businesses to achieve what is possible. Though the objectives that have been identified are national guideposts--as distinct from Federal standards the Federal government has consider- able capability to contribute to their attainment. Prevention 'SO is offered as an annual report to describe the Federal prevention activities, review the major accomplishments of the past year, and establish a mechanism for tracking our progress. It is our hope that this report will also facilitate the efforts of health professionals and program managers engaged in similar activities in States and communities throughout the country. With a cooperative commitment of energy, imagination and will, the decade ahead can offer an exciting opportunity for even greater gains for the health of Americans. J. Michael McGinols, M.D. Deputy Assistant Secretary for Health and Assistant Surgeon General

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Contents Prefsce .................................................................................. v Chapter I : Prevention Highllgbt~ ............................................................ l Chapter 2: Health Statu~ Trend~ ............................................................. 7 Chapter 3: Agency Innovations .............................................................. 33 Department of Health and Human Services Public Health Service ............................................................. 34 Other DHHS Agencies Health Care Financing Administration ............................................... 69 Office of Human Development Services .............................................. 70 Other Federal Agencies ................................................................ 72 Chapter 4: Prevention Inventories ............................................................ 77 Table 1. FY 1979 and FY 1980 Resources for Prevention Activities by Agency Department of Health and Human Services ............................................... 78 Table 2. FY 1979 and FY 1980 Resources by Prevention Priority Area Department of Health and Human Servlees ............................................... 79 TabIe 3. DHHS Agencies Reporting Prevention Activities in 1980 by Priority Area ............................................. 80 Table 4. FY 1979 ~md FY 1980 prevention Inventories by Agency and Priority Area Department of Health and Human StTvices ............................................... 82 vii

Figures Figure I. LeadingCausesofDeathinlg(iOand197g .......................................... 9 Figure 2. TrendsinAge-AdjustedDeathRatesFtomSelectedCauses:sele~tedYears, 1900.1978 ..... 10 Figure 3. Major CausesoflnfantDeaths: 1950and 1978 ....................................... 11 Figure 4. PercentageofInfa.ntsofLowBirthWeight, ByRace: 1950-1978 ........................ 12 Figure 5, TrendsinRef:~>rtedlnodeneeRatesofTenSelcctedBirthDefe~'q~: 1970-1979 ............. 13 Figun~ 6. MajorCausesofehiltihoodDealhs: 1950and 197g ................................... 14 Figure 7. TrendslnAccidentalDeathRatesforChiMren, FromseIectedCau~e*: Selected Years, 1950-197g ........................................................ 15 Figure g. TrendsinReportedlncidenccRatesofChildhoodDiseases:SeleetedYears, 1950-1979 ..... [6 Figure 9. Major CausesofAdolesccnt Deaths: 1950and 197g ................................... 17 Figure 10. Trends in Death Rates for Suicide, Homicide, and Motor Vehicle Accidents Among Adolescent Males, By Color: Selected Years, 1950-1978 ........................ I g Figure 11. Trends in Death Rates for Suidde, Homicide, and Motor Vehicle Accidents Among Adolescent Females, By Color: Selected Years, I950.1978 ....................... 19 Figure 12. Cigarette Smoking Among Teenagers, By Age and Sex: 1968, 1974, and 1979 ............. 20 Figure 13. Cigarette Smoking Among Young Adults, By Race and Sex: 1965, 1976. and 197g ......... 21 Figure 14. Major Causes of Adult Deaths: 1950and 1978 ....................................... 22 Figure 15, T~nds in Death Rates for Heart Disease and Stroke Among Adult Females, By Color: Selected years, 1950.197g ........................................................ 23 Figure 16. Trends in Death Rates for Heart Disease and Stroke Among Adult Males, By Color: Selected years, 1950-1978 ................................................ 24 Figure 17. Age-Adjusted Cancer Death Rates for Males, By Site and RaCe: Selef.ted Years, 1969-1977..25 Figure 18. Age-Adjusted Cancer Death Rates for Females, By Site and Race: Selected Years, 1967-1977 ...................................................................... 26 Figure 19. Trends in Selected Alcohol-Associated Causes of Death: 1949-1978 ..................... 27 Figure 20. Trends in Apparent Per Capita Ethanol Consumption, Based on Beverage Sales: 1944-1978 ...................................................................... 28 Figure 21. Major Causes of Older Adult Deaths: 1950 and 1978 .................................. 29 Figure 22. Trends in Death Rates for Pneumonia and In nuenza Among Older Adults: Selected Years, 1950-197g ........................................................ 30 Figure 23. Trends in Re~t tiered Acdvit y Days and Bed Disability Days Among Older Adults: 31 1960.1979 ....................................................................... viii

Chapter 1: Prevention Highlights Recent years have ~eet~ impre~slve gains for the health of Amerlcans--gains largely accomplished through the prevention of disease and disability. In I979, the Surgeon General released Health~ People: The Surgeon Generel's Report On Health Promotion and Disease Prevention, which chronicled the important changes in the health status of Americans since the turn of the century and outlined national goals for the future. Even in the short time since the release of the Surgeon General's Report. prominent advances have been made toward those goals. Prevention "80 summarizes some major developments now under way in prevention and reviews the Federal contributions to achievement of our prevention objectives. This first chapter presents five particularly important achievements receiving special recognition within the last year that exernplify the potential for further advances: the eradication of smallpox, enhanced childhood immunization, the decline in infant morality, the decline in heart disease and stroke mortality, and the hypertension detection and folIow-up program.

Prevention Highlights Smallpox Eradication The conquest of smallpox, officially declared in May IPgO by (he Assembly of the World Health Organization, was one of the most important achievcrnent~ in the history of puhiic health. Irx Ociohrr of 1977. the last documented epldemlc case of smallpox OCcurred in Marka. Somalia. ending a scourge that historicaffy has been a leading cause of unnecessary death. The United States was a major contributor to the woridwlde effort directed by the World Health Organization, having provided nearly a fourth of the WHO and bilateral aid budget, as well ~.~ the services of el~idemiologicai consultants, largely from the U,S. Public Health Servicc'~ Center for Disease Control. Smallpox is the first disease ever eliminated through a carefully designed and implemented program. Early Asian writings indicate that smallpox was long prevalent in the more densely populated parts of Asia, and it probably reached Europe around the sixth century. E~timat~ vary as to the early death rate, but references taken from documents about epidemics of the 17th and lgth centuries suggest that the death rate among those who con- reacted smallpox was between 20 and 50 percent. From the ]3th through the Igtb centuries, civilized man explored the new world, and as im- proved transpOrtatiot~ and the need for commerce ended the isolation of many remote areas, smallpox epidemics followed and led to the dec~matlon of entire popaiat~on~. By Ih¢ middle 1700s, smallpox in the United States was believed to account for 10 percent of all deaths, and was ihr leading catlse of in f~nt death. Clues to control of the disease emerged over centuries. As early as 2.500 years ago, peac¢i- tioners in China and India found that varlola- lion--development of a light ease of smallpox through deli'0erate ~noculation with material from smallpox pustules or ~¢abs---<oaid confer imrnnnl- ty to the disease. The death rate o[ 1 or 2 percent from variolal~on was far less ~han the expected death rate from the natural disea.~e. In I978, the English country physician Edw,~rd Jenner documented the fact that srn~dlpox im- munity; could he obtained through inoeul~ion with the much milder cowpox. His prediction that this practice would result in "the annihilation of smallpox" marked the bo~Jrming of a finest that succeeded 179 year~ later. In spite of the growing wide-scale use of smallpox vaccination in the lg00s and early 1903s, the disease remained endemic throughout the woeld during much of this century. Tho~c who were riot immune ran a high risk of being stricken sometime during their lifetimes. Following World War [I. the concept of worldwide eradication gained new suppor tees as smallpox was ~ucct:ss ful- ly edmina~ed f[om North America, Europe, and a number of other countries willing and able to vac- cinate the re*crvoirg of nonimmune indlvidua]$ in population centers, and to prohiblt travelers from crossing their borders without evidence of smallpox vaccination. In I949, the last ittdigenous ca.~e of smallpox in the United States occurred in tbc Rio Grande Valley in Te:~as. To strengthen the global program, in 1959 the World Health Assembly passed a resolution directed at smallpox eradication, and the World Health Organization, UNICEF. and other organ- izations offered heIe to those eovntri~ w~li~ng to uIlder take mass vacclnations. However, it was [lot until 1905 that the commitment to worldwide Pra(i~¢a~ion of smalfaox was angrl~ettted with budget and bilateral a.ssignmenls sufficient to make feasible the gaal of eradication by 1976. In 1967 the disease was still considered endemic in 33 count~ics, and eases attributed to travel through

these area~ had been reported in I 1 other nations, By I970 only 21 countries reported cases, and 16 did so in I971. The sinai[pox eradication program was maitl- faceted. Techniques of mass vaccination programs were improved, and costs d~creased with the development of the jet injector gun and the bifur cated needle. Production and quality control for vaccine production were also greatly improved. Ultimately, a highly developed surveillance/ local conlainment program provided the measure of success. Workers systematically searched for cases and moved rapldly into any area in which a case was detected, sealing off the spread to other areas, isolating the patients, and finding and vac. cinatlng contacts. By 1974 the fight to er adieate smallpox was near success, with Pakistan's last case reported in 1974, NepaPs in April 1975, India's in May 1975, and the last in Bangladesh in October 1975. Ethiopia'~ last reported case occurred in 1976, and the last cases in Kenya and Somalia were reported in I977. A laboratory accident in England in 1978 pro duced the last verified case of smallpox. The Global Commission for the Certification of Smallpox Eradication required that a two-year period Pass without any naturally transmitted cases before the disease could be considered to have been eliminated. That period ended in Oc- lohor 1979, and the smallpox virus is now housed only in selected laboratories. Childhood Immunization Ociuber 1979 also marked the successful com- pletion of the two and a half year National Childhood Immunization Initiative. This effort was begun in 1977, when surveys revealed that over a third of school-aged children were inade- quately immunized against the major vaccine preventable diseases. A goal was established to raise the immunization levels to over 90 percent by the fall of 1979, and program activities were tailored to meet that goal. Today, of the million children in kindergarten through eighth grade, 91 percent are adequately immunized. Of those newly entering school in the fail of 1979, 94 percent had been immunized against measles, 93 percent again.st rubella, 87 percent against mumps, 93 percent against polio, and 94 percent against diphtheria, pertussls, and tetanus. Cases of these diseases have also declined in number. In fact, remarkable progress has been made since the 1950s in the reduction of vaccine- preventable diseases throughout the United States. Only 30 years ago the childhood dls~ produced extensive mortality and residual disability in this country. The 1955 Poliomyelitis Vaccine Assist- ance Act. later expanded by the Vaccine Assist ance Act of 1962, supported extensive growth in State-levai programs to provide all children with immunizations against the major childhood vacclne-preventable diseases. As more vaccines were developed and depinyed, the fist of diseases to be combated expanded, and the number of reported eases fell. However, as the disease in- cidence fell. efforts to immunize all children did not receive the priority warranted, and levels of immunity to many of these diseases among children crested and. in some cases, fell. The nationwide Immunization Initiative an- nounced in April 1977 was developed to ensure that the Nation's children would be immunized against seven vaccine-preventable diseases: poiiomyeiitis, diphtheria, pertussis (whooping cough}, tetanus, memsles, mumps, and rubella. Particular attention was paid to tht; gap in im mualzation levels between affluent communities and Iow-lncome areas, and in the differences be- tween levels in school-aged children and preschoolers. AS part of the effort to achieve the goal e;tab- lisbed, the Department of Health and Human Ser- vices increased grant support to health depart- ments for immunization activities, strengthened the emphasis on improved immunization levels for users of grant-supported primary care facilities serving low-income populations, and launched a national outreach and education effort to en- courage immunization. Organized professional groups making substantial contributions to this ef- fort included the Amerlean Academy of Pediat- rics. the American Medical Association, Ihe Na- tional Medical Association, the National League for Nursing, and the American Hospital Associa- tion. Local chapters of volunteer groups such as the National Council of Negro Women, the General Federation of Women's Clubs, the Parent-Teacher Association. and the American Red Cross contributed significantly at the com- munity level. Business and labor organizations participated in both publicizing and implementing the objectives of the campaign. A particularly important feature was the vigorous enforcement by school systems of school entry immunization laws, with expanded require- ments to include immunizations for more dis~. For example, the number of States requiring im- munization against mumps increased from two in 1977 to 18 in 1979, and five States enacted school entry immunization laws for the f~rst time during the same period. Today at[ 50 States have school entry statutes to help ensure that all youngsters are ~ .......................... As a consequence of these successful efforts, the Public Health Service has reaffirmed its commit- ments to maintain immunization levels among all children, to elimlnate measles as an endemic 3

disease in the United States by 1982, and to im prove the reporting of childhood diseases for bet- ter tracking of the incidence of outbreaks. Decline in Infant Mortality In 1979, the in fanr mortality rate ia this country continued to decline and reached the lowest point ever achieved, 13 deaths per 1,000 llve births. This achieveme~l is Mrgdy the result of advances in perinatal and neonatal medicine, improvements in the delivery of caye to ~othcrs and infants, and improved techniques for early identification and treatment of those pregnant women and infants who are at high risk. The decline in infant mortality since 1900 has been dramatic--more than it sevenfold dccfine from the 1900 leval of 100 deaths I)cr 1,000 live births. During the past 10 years, the rate has decreased from 19.2 in 1968 1o 12.0 in 1978 for whites and from 36.2 to 23.1 for blacks. Ahhough these are significant improvements for both groups, there r~snaln large differences among subgroups of the population and among geographic areas. It is important to note that total infant mortali- ty represents the combination of early infant deaths (neonatal) and those occurring after the first month of life and before the first birthday (postneonatal). Problems and intervention strategies differ between these two components, and iroproeetaents have occurred for both. Neonatal deaths--those occurring in the first 28 days after blrth--!argely represent orenabal and perinatal circumstances and events. Consequently, family planning, prenatal care with risk assess- ment and management, and newborn intensive care constitute the most important measures con- tributing to the reductions of neonatal deaths. Since the causes of postneonatal deaths reflect aspects of the infants' environments, important preventive measures include parenting in~truedon for new parents, illness sul'velifallee, and ap- propriate use of pediatric services. Neonatal mortality accounts fo~ more than two thirds of infant deathsl a substantial portion of the gains made during the past 20 years can be at- Cfibuted to developments in rtcona~ology and the establishment of regionalized networks for perinata] =ate. Care of blgb-risk preguant women and intensive care of newborns, particularly for low birth weight infants, have imeroved slgnifl- tautly. Improved prengtal nutrition, control of certain diseases like rubella that may affect the fetus if contracted by the mother during pregnan- cy, and reduced substance abuse during pregnancy (smoking, alcohol, and certain drugs) may also contribute to reductions in infant death rates. If the currently successful trends in reducing neonatal deaths continue through the 1980s, future improven~ents in infant health may depend on our ability to prevent postneonatal problems. A number of Federal efforts have contributed to the progress made in reducing infant deaths. The Maternal and Child Health Program, which dates back to pas~ge of the Social Security Act in 1935, provides grants to States for maternal and infant services. The States operate oomprehensive programs ~naludiag crippled children's sefvi~q and special projects in family planning, maternity and infant care, Jntensfae care, sch~oJ health, and dental heaith. The Improved pregmtncy Outcome initiative and Improved Child Health projects are further efforts initiated through the State grallt program to improve the health of pregnant women and children. Other aedvltiaB include a recently authorized program to fund comprehensive services and preeentlon projects to deft with adolescent pregnancies, special nutrition I~rograms ad- ministered by the Department of Agriculture for pregnant women and infants, the direct reim- bursement for medical care provided tinder Medicaid for eligible low-income women, and the comprehensive soalal services covered untiar q?itie XX. Through the National Institute of Child Health and Human Deve/ogment (NICHD), a multidlsclplinary research effort addresses the ear- ly Jdentlficatfan and reduction of risk factors associated with infant mortality. The combination of these efforts with participa- tion of Stare and local agencies has been tt signifi- cant factor in the impressive improvements of re- cent years and can be exlx'eted to yield further gains in infant health in the 1980s. Decline in Heart Disease and Stroke Mortality In the decade from 1968 to 1978, age-adjusted death rates for heart disease lieclined by 22.7 per- cent, and stroke deaths declined by 36.5 percent. indeed, heart disease and stroke death rates have dropped dramatically Mince 1950. Although heart disease continues to be the leading cause of death and stroke the third leading cause, there have been substantial gains in the fight to prevent these chronic and disabling diseases. These trends bear important witness to the fact that certain elements of chronic discuses need not always be inevitable consequences of the aging process. Between 1950 and 1970, the age.adjusted death talc for all heart dlse~-.~--inc!uding cong~tlve heart failure, rbeumatlc and hypertension-related heart dlsease--fog 18 percent, or an average of one percent every year. From 1970 to 1978, the rate declined another 18 percent, or approximately 2.5 percent each year. Far stroke, the 1950 to

1970 decline was 25 percent; and the 1970 to 1978 decline, an addbional 33 percent. Theqe achieve- ments cart be attributed both to improvements in treatment of individuals with these conditions and to pre'centlon activities that reduce the incidence of such conditions; however, the relative contribu- tions of prevention and treatment have not been determined. The Federal contribution to reducing heart disease and stroke deaths has a long history, dur ing which the role of prevention has continually increased relative to that of treatment. Major epidemiologic studies supported by the National Institutes of Health and conducted in the 1950s and I960s provided the evidence for defining cer lain risk fat(ors associated with heart disease and stroke, and for developing intervention strategies that are associated with reduced morbidity. For example, these studies identified high blood pressure not only as the most important risk factor for stroke but also as a major contributor to cor- onary heart disease. Recent successes in control- ling high blood pressure have clearly contributed to the decline in deaths from stroke and heart disease. In the early 1970s, the National High Blood Pressure Education Program began, with partici- pation by government agencies, private industry, voluntary health associations, and professional groups. This public and professional education program--coordinated by the National Heart, Lung, and Blood Institute has been effective in decreasing the proportion of undetected cases of high blood pressure and in increasing the level of ~ontrol for those cases detected, While progress has been substantial, the opportunity for even greater advances in the control of high blood pressure is reflected in the following section about the Hypertension Detection and Follow-up Program. Another major risk factor identified in these studies and targeted for special attention is cigarette smoking. The I964 Surgeon General's Report on Smoking and Health was a landmark in identifying this major contributor to both heart dise~.qe and cancers--indeed, uRimatdy as the single most important preventable cause of death. Efforts by DHHS to reduce smoking and its risks continue to expand, and have produced positive results. AduIts are quitting smoking at a greater rate than they are taking it up, and those who do smoke are choosing dgarettes with lower tar and nicotine. Among teenagers, the proportion of smokers has declined substantially. The sole ex ception is teenage females aged 17 to 18, among whom the proportion currently smoking has re- mained stable during the past five years. Studies also identified dietary factors important in heart disease. Premature heart disease is dearly associated with elevated blood cholesterol levels. Heart attacks are five times as frequent among men and women aged 35 to 4,1 who have choles- terol levels above 265 milllgrams/deciliter as among those with levels bdow 220. Recent trends indicate an overall reduction in consumption of saturated fats and cholesterol. This decline, combined with increasing public awareness of the relationship between diet and health, may also contribute to decreases in heart disease deaths. The fact that cardiovascular dlsease---our Na- tion's leading killer-- has been declining, and that the rate of decline has been accelerating in associa- tion with enhanced efforts directed at the major risk factors, is especially encouraging. Additional progress can be expected as the knowledge base deepens with respect to the involved risk factors, and with respect to effective ways of addressing those risk factors. Hypertension Detection and Follow-up Program A prominent exam#e of the potential for addi- tional gains resulting from an expanded knowl- edge base is found in the results of the Hyperten- sion Detection and Follow-up Program, announced in December IWl9. This study has been a five-year, randomized clinical trial and provides new insights into the possibility of reducing mortality for the large numbers of people with hypertension, in- cluding those with mild hypertension. The systematic intensive detection, treatment. and follow-up program undertaken nationally in various centers resulted in a significant decline in mortality from all causes and showed clearly the benefits of treatment for persons with mild as well as moderate to severe high blood pressure. People with mild high blood pressure~iastollc blood pressure 90 to 104 at the baseline clinic visit--whose high blood pressure was subjected to aggressive control, experienced death rates 17 per cent below those with similar levels who were not participating in the intensive intervention pro- gram. Moreover, it was noted that the aggressive follow-up program was even more successful for blacks. Mortality rates for blacks in the program declined 22.4 percent relative to those of the con- trol group, while rates for the others in the ex- perimental groups declined by I0 percent. The implications of these results for the health of Americans are substantial. High blood pressure is widely prevalent in the United States: An estimated 60 million Americans have blood pres- sure readings higher than 140/~. An important contributor to stroke, hearl disease, and renal disease, high blood pressure is estimated to cost the Nation more than $g billion each year in medical care costs, lost productivity, and lost wages. 5

Although Faderal]y ftmded studies in the late 1960s and early 1970s clearly demonstrated that high blood pressure co~Id be controlled, and that related disease and death for whire middle-aged males would decrease accordingly, the National llealth and Nutrition Examination Survey indi eared that about 50 ~.er cent of affected individuals were ~naware that they bad high blood pr~sure. In 1972 the Public Health Service, through the National Heart, Lung, and Blood [osthule, ap- pointed a special panel to examine these problems and to recommend addldona[ studies as; needed. A large-scale clinical trial was recommended to pro- vide data On the ef~cacy of a.ntlhyperteilsive therapy in controlllng disease and prcventlng death [or the general population. This study, the Hypertension Detection arm Follow-up Program, began in 1973 and has tn- vdived 14 clinical centers and nearly 11,000 hypertensive patlenls. The ~calicnts were then be- tween 30 and 69 years of age, Of both ~exgs. and ineluded both blacks and whites. They were ran- domly assigned to the c[Idical centers for therapy, or they were referred to their usual sources of earc. Deaths flora all causes w~re tracked, ~tnd the re~ults t~vealed the dramatic f/re year mortality reduet[on$ noted above for thos~ treated by the ~l]nical c~ater$ as ~ompare~ with those referred for lreat~nent of hypertension by customary ~ourees Of care. One of the important next step~ is the applicallon of these ~ndings in regdiar Primary care settings to determine which com- ponents of the lreatment and fo{low-up reglmetl ~an ¢ontrlbutc to ~ner~bed eon!rbl r~te~ amon~ high-rlsk groups. Smallpox eradlcatio~, immutdzat[on i~prove- ment~, reductions in infant Inortalfiy, declines in 6 h~art disease and stroke mortality, and the sue~ cessful reduction of mortality though by~r~en- ~iotl detection at~d [ollowott p arc five achlevcmert t s that demonstrate, by example, the ~trides that can be ~de against all the prevefitabl¢ disease~ through a combination of enhanced prev~ntioll s~)rvlces+ changers in the environment, and tht adoption of risk-reduclng lifestyles. Based on an assessment of the prospects offered by these and similar opportunitles to prevent un~ necessary disease and disability, specific godis were established in Healthy People for im- provements in the health of Americans in each of the major life stages: Healthy [n[ant~: To continue to improve bl- fant health, and by 199Q to reduce infant mortality by a least 35 percent. ~ealthy Chadian: To improve child health, foster optimal childhood development, and by 1990 reduce deaths among children aged 1 In 14 years by at least 20 ~erccnt. Htadlhy Adolese~;t~ ~ Youn~ Adidt~: To improve the health and health habits of adolescents and young aduRs, and by 19~0 to reduce deaths among people from 15 to 24 years old by at least 20 percent, Healthy Adot~: To improve the health of adults, and by 1990 to reduce deaths among people aged 25 to 64 by at least 25 perc~m. Healthy Older Aduh~: To improve the health and quality of life for older adults, and by 1990 to reduce the average annudi number of days of restricted activity because of acute and chronic illness by 20 percent, to fewer than 30 days pet year for people aged 65 and older. ~,oth Healthy People and Promoti,~g Health/ Preventing Disease: Objectives for the Nation. the volnme issued the following year to sveci~ the ob- jectives more comp[e~ely, have been directed to the identification of nadonalsas distlnct from Federal--goals arid opportunities. Bqt, as noted in th~ five examples just reviewed, a great d~al carl be cot~trlhut~ by vari~zls Federal program~. Tha~ is largely the subject of this report. ]~'e~¢ntio~ "80 is the first in a series Of annual reports that will highlight the leading acCom- plishments in prevention during the previous year, me, asur~ the Nation's p~ngres~ toward ~L~ preven- tiort objectives, and summarizt the Federal eon- trlbudons ¢o achievemen~ of the objectlves. This lirst chapter has pre~ented several significant recent accomplishments. The remainder of the report will detail the programs and the progress. Chapter Two a~ses~,es our Progres~ in Oahanelng bexlth by re0orfing treads in healt/x ~tatul ir~ dicator$ [or five ag~ groups: infant~, children, adolescents and young adults, adults, and older adults. Chapter Thr~e chonlcles the effort~ of Federal agencies in the broad range of prevention priority areasmnot ably lhe work of the Del~art- ment of Health and Human ~ervlce~, but alga ac- tivisie~ of other Federal ogenc/e~ at~d deparlmCnta, Chapter ~¢ot~r provides a complete inventory of prevention acllvitfes, argot db~g to prevoltion pro- gram categories, within the D~artment of Health and Human Services, Taken a~ a whole, the effort~ described in these chapters represent stlbstalltiel growth toward the prevention measttres needed to meet th~ goal~ of Healthy People.

Chapter 2: Health Status Trends Progress ~n disease preven[ion musl be mea- sured in terms of lhe reductions of preventable health problems the absence of illnesses, in- juries, and deaths {hat, based on previous ex- perience, might otherwise have been expected t0 occur. This chapter of Prevention "80 displays in chart form various aspects of health-related trends, both for the population as a whole and among the five age categories established by Healthy People. These include infants (under 1 year), children (1 to 14 years), young adults (15 to 24 years), adult,, (25 to 64 years), and older adults (65 years and older). The health trends depieled in these charts highlight the major causes of disease and death for each age group. 7

Health Status Trends Overall Trends In 1978 the National age-ad~usted~death rate declined to 606 per I(~0,000 people, the lowest level ever recorded in the United States and a 66 percent reduction from the 1900 rate (Figure 1).2 This dramatic reduction demonstrates the Na- tion's success in preventing and treating acute in- fections and diseases. Influenza and pneumonia death rates, for example, fell from 210 to 15 per leO.000 population, a decline of 93 percent. On the other hand. death rates for many chronic diseases have increased. Cancer rates have risen since the turn of the century from gl to 134 per ICO,0C0; heart disease death rates have increased from 167 to 208 per 100.000. Interestingly, the rate of death from stroke declined from 134 to 45 per 100,000 population, and the death rate from accidents declined from 76 to 44 per 100,000. The decline in the age~ adjusted stroke death rate was consistent with the overall de~th rates, so that in 1978 it accounted for approximately the same proportion of deaths as in 1900. As described in Chapter 1. successful efforts to reduce the number of deaths from both heart disease and stroke have more recently effected substantial decreases in the death rate from these diseases. Note the differences in trends in age-adjusted death rates from selected causes for the period 1900 to 1978 (Figure 2). Death rates from heart disease increased between the year 1900 and about 1950, then declined at an accelerating pace. Death rates from cancer, on the other hand, increased rapidly during the first half of the century, and continued to increase, though more slowly, through 1978. Death rates from stroke have de= creased steadily since 1900. The most dramatic de- creases were for the infectious diseases such as in- fluenza and pneumonia, for which reductions of 80 percent were achieved belween 1925 and 1950. The contrast between falling influenza and pneumonia death rates on the one hand, and rising cancer death rates on the other, provides a dra- matic example of trends with complex roots. Mul- tiple factors are clearly involved: life-saving im- provements in the prevention and treatment of in- fectious diseases; changing lifestyles, both detri- mental and favorable to health; a changing environment; and, not the least important, the im- proved standard of living that has alleviated ¢on- ditions contributing to susceptibility to disease.

Overarl age.adjusted de~th rate per 100,000 for tl~e leading causes of death in 1900 comparc'<J with 1978. Numbers in parent heses indicate percentages of total age adjusted (/eat h tale Source: NCHS, "FIr~l Mortallly S~atlstics, ~978," Monthly Vitat Statistics F~e~orL VOL 29, NO ~, ~uDDle~ent ~, Se~ember ~7, 1~3,

10 S 4

Healthier Infant~ Continuing a long-term downward trend, in 1978 the rate of infant deaths reached the lowest level ever recorded in the United States--fe~er than I4 for each 1,0O0 live births. Since 1930, the overall rate for infants has fallen bv about one haft, reflecting reductions in most causes of infant deaths. Infant deaths from influenza and pneu- monia dropped dramatically from 237 to 46 for each I(]0.0GO live births between 1950 and 1978, a decllne of gl percent (Figure 3). In 197g, about 48 percent of the deaths were caused by immaturity and blrth-associated conditions. These conditions included respiratory distress syndrome, hyaline membrane disea.~e, unspecified asphyxia of the newborn, birth injury without mention of cause, and other complications of pregnancy and child- birth. This 1978 rate represents a decline in the proportion of deaths from these causes from about 62 percent of all infant deaths in 1950, and is consistent with a drop of nearly 53 percent in the overall infam mortality rate (Figure 3L The proportion of low birth weight infants-- those newborn infants weighing less than 2,500 grams (5 pounds g ounces) is an objective, easity tracked measure, probably best correlated with deaths from immaturity and other birth-associ- ated conditions. Trends in percentages of infants Figure 3. Major Causes of Infant Deaths: 1950 and '[978 Ae~ Group - L~$ ~n 1 Yw f~,nk Ce~la~n CaUSeS el mortality ~n early infancy Infant mortalffy rote per 100.¢~0 ll~ btrlhs 1 r978r 47,9 percenl ]859.6 1930 ~!~ 58.,'percen ~ : : ~ ~ : L~ 17154 Congenital anomarie~ I 18.3 percent ] 252,1 ¢nllu~ an¢l pnE~d me nia 3.~lPerCenl ,3.3 percenl 46.0 ~ 237 4 Accidents 2.7 percent 37.9 ~eent 10~1 SePtleemM Percer~tage of totar mortality rate shown In bar. 5 ~ 4 percent 32.8 [~ 1978 (Total fate 1378.4) 2 ~)ercent 5.0 ~ ~0 (Total rote 2921 B~ I I I I I I I I 0 250 500 750 1000 1250 1500 1750 (a) NOt I~tnkecl ~n f~rst 10 leading cau~e~ of d~t h~ Sou~c~ NCHS~ V/tal ~tahstfc~--~pec~al Pepor~--Natlonat Summar/es, ~gS0~ Vo~ 37~ NCH~ ~F~al Mortality Slalisl~cs~ 1978," Monthl~ Vit~f ~ta ~i~ lic~ RP~0or t, Vn~ 2g~ NO 6~ gul)~mP.nt ~ S~pl~rnber ~7~ ~8~ 11

F]gure 4. PercQntage of Infanh; of Low Birth Weight. By Race: 1950-1978 I~prce~fage 15 ~ includin~ 81ack 10 ~ White 0 I L I 1950 ~9C-~ 1970 19B0 Sources: NGHS, Factors A ssocJated with Low Birth Weight, U S, 1976, Series 21, NO. 37. April, 19B0; NCHS, "Final Natality Slati~ics, 1978." Monthly Vilal Statistics ~eporK Vol. 29. No 1, Supplemenl, A0ril 28, 1980 of low biTth weight peaked in 1965 and 1966 and have declined gradually since then (Figure 4). Al- though since I966 ~maIler proho~on~ of both white and non-while newborns have fallen in this range, large disparEties ir~ percentages of low birth weight i~lfants persist ~norlg th~ races, tlnderscor- ing the special inl~or t arlce of addr esslng Ihis prob ]em among black worfien of ¢hildbearlng age. A n~lmher c~f maternal factors ¢:onlr~bute to lOW birth weight, inch~ding lack of prenatal ~arc. Poor nLt~rJtior~, srtlok~ng, alcohol aru] dr~g use. ~g~. race. artd ~ociaI ~u~d economic backgrotlnd Conget~it a] defects were the leading single iden- tifiable cause of infant deaths in [950 and ~n 197g. This group of birth defects comprlses those caused by deveIopmet~tal Or ger~etl¢ problems rather than injuries m utero or during birth Though the In- [ant mortalitY rate for congenital anomalies fell somewhat, from 396 to 252 for each 100.030 llve births, the actual incidence of specific congenital birth defects remained relatively stable (F~gere 3) Oztly recently has it become possible to lrack the incidence of birth defect~ with the bene ~'it of a na- tio,al birth defe~ts detection and reporting system ~2

It ~s estlrnated that between 1970 and ]97~ the total number of birth defects reported for the ten mort common types showed a sinai1 decllne (Figure -~). For some birth defects, spina biffda wlthout anencepha]y, for example, there was a small decline during the 1970s; while for others, such as hypo~padlas, there was a small Jrlcrease. The fact that death rates from birth defects have fallen over this same period, while the incidence of b~rth dcfccts has not, reflects advances in neona- tology, delivery technlques, urgent care for new horns, and special surgical methods. Preverttion actlvlt[e$ d~rected toward reducing birth defects include: immuni?~don against rubella (German measles) to prevent oecurrence of the disease during early pregnancy; J]ltrauterine diagnosis and Jnterv¢l~tlon for severe defects; genedc counseling for parcms at high risk of hav- ing infants with birth defects; public education campaigns to emphasize the haT~rd$ to the fetus presented by aXcohol, drugs, and tobacco; and special attention given to Jd~ntJfieation of toxic exposures that might injure the devefeplng fetus. F~IU re 5. Trends In Reported incidence Rates of Ten Selected B(rth Oefects: 1970-1979 Rate per 100,000 bldhs 10 5 4 3 0.5 94 03 02 f 01 I i I I I I I I I 1970 1971 1972 1973 1974 1975 ~976 1977 1978 ~979 Totar for ten se;~ct~l bldh def~t~a -- Hypospadtas; Down syndrome Spina biffda without anencephaly (a) "Selected detects" arP the folrowi~g ten defects, whic~ were selected from among those tracked by the Center for t)Jsease ContrOl Bidh Defects Monitoring Program: anenCephaly. $0ina 13if ida without anenc~ph~ly, ~.ydroc~phalus wilhout s~ina ~i!id~, c!eft Palate without c!ef~ !~p, ~ota~ cleft lip, tracheo~So~hageal fi~tula, rectal atresia acid stermsis~ ~lypo~padla~, redtlctieJit d~Iormity, ~nd D(lwn ~'fldrome Ifldividual births are counted more Ihan OrtCe if more tharl on~ defect is repo~t~d, 5oL~Ice: Centers tot Disease Control, October 1978

gigure 6. Major Causes of Childhood Deaths: 1950 and 1978 Age ~mup 1.14 y~rs Rate ~r 1~,~ ~ula~n ~#nk Accidents 27.6 Caner ~t 4,4 i Congenial anomalies ~8.2 ~rce~t 3.55.4 Healthier Children From 1950 to 1978 the death rate for children aged I to 14 fell from ~6 to 43 per 1~.~ popula- tion, a reduction of more than 50 percent, The change in rates for particular causes of death has varied widdy in both magnitude and direetlon ~ince 1951) (Figure 6). ACcidents, still the single largest cause of death among children 1 1o 14, declined 29 percent -- frona 28 to 20 per lO0,O00--between 1950 and 1978. Motor vch/de acc~denls accounted for =bout half the accidental deaths in this age group in 1978; although there weee fewer such deaths from 1973 to 1975, 5ollowJ.6 the gasoline shortage and adop- tion of the 55-mile-per-hour speed limit, more re- cent trends for this cause have not been favorable {Figure 7). Homfelde 4 3.7 ~r~e~t 1.6 ~t 0.6 Inlluenza and Dneumoni~t 25 ~3"3 percent 8.71 4 I I I 0 5 1u Pe¢centage of to~l mortalffy rate ShOWn ~n b~r. ~--~ 19"/8 (Total rate 42 9) ~195~ (TOtat rate 87.7) ~ 20 ~5 30 Sources: ~HS, Vifat Sftt[l~tfcs Sf~eC~[ tTeporfs~Nall~oaf ~tlrnmariea, tgSO, VOf 377 ~HS, "Ftna[ MoHafiW 6{atistics, ~978," Mo,lthly V/tel 6taff~tJcs ~eport. V~l ~ No. 6, Supplement 2, ~ptem~r 17,19~. 14

Other major causes of accidental deaths for children are burns, falls, and poisonings, all of which have drol~ped since [950, while the rate o~" drownirt~$ h~s r~maitlod comp3r3tive]y cot~$tant (Figure ?). AIcohoI is a significant factor in many of these accid~tal deaths; cigarette smoking is a ~ctor in many firc-rc]atcd deaths; and a sub$tan- tlal [~roporfion of drownings Occur in Ilna(tended bodies of water. A major challenge for the ]980s will he to find effective measures for reducing motor vebiclc fatalifies for chiIdren while confinu- ;ng our efforts to control the ot }~er cl]tlses of acci- dental deaths, Since 1950, impressive reductions in death rates among children have also occurred for in[luenza and pneumonia and {or cancer (Figure 6). The in- fluenza and pneumonla death rate foil by 84 per- cent for children, a partlcu[ar]y pronounced drop for this age group, although the decline occurred among all groups under age 65. Improvements in access to health Care and in ]ivlng conditions for Iow-lncOrll¢ and minority groups have hccn impor- tant contributors to this reduction, along with ad- vances in mc~lica] treatment and in prcvenfion through immunization. Figure 7, Trends ;n Accidental Death Rates 10¢ Children, Ft'om Selected Causes: Selected Years. 1950-1978 R~te I:~r 100.~ population 04 03 02 All accidents OrOWnlnqs Burns 15

Figure 8. Trends in Reported Incidence Rates of ChBdhood Diseases: Selecled Years, 1950-1979 Ral@ per f00,OOO populstlon 50C ~(X %* ~ Chteken p~ °1 \', 0.~ Diphlher~ 0.0t ; I Peli°myelitis 1¢J50 1955 !980 1965 1970 1~J75 1979 Sources: CDC, Morbidity and Mo~hty Weekly Nepoa, geptembee 1979 and September 1980. The 48 percent reduction in rates of death from cancer among children is largely attributable to improvements h~ early detection and treatment of childhood ]eugem~. The death rate from leo kemla has been reduced by approximately one half since I950. Another major target of the national prevention program is the incidence of childhood vaccine-pre- ventable diseases (Figure 8). The remarkable aehlevtments in reducing the incidence of these did, eases reflect the suece~ses of immunization pro- grams for children, However, occasional short- term revertuds of trends (e.g,, between 1974 and 1~77) under,core the need for pursuing vigorously the highest possible immtlnization levels for young children. 16

Healthier Adolescents and Young Adults Since 1950 the overall death rate For 15 Io 2~year-olds has declined about 8 percent, while the changes in death rates for lhe various causes have varied widely (Figure 9). As with children. the single largest cause of death in this age range is accidents; but among adolescents and young adults, motor vehicle accidents account for more than 70 percent of aIl accidental deaths. For young people, death rates for infectious diseases, cancer, and heart disease declined, but death rates for suicide, homicide, and accidents all increased be- tween 1950 and [978. Homicide 2 ~11"2 ~rcenl 132 5 49 percent 6.3 Suiel0e 63 ~106 Pmcenli[ 4512"4 Cancer 4 ~5,4 percent 63 3 i6.7 percent 8.6 Heart disease ~2"3 pereer~t 6.4 percenl I 10 Percentage of total mot tali~y rate shown in bar 27 ~ lg78 (Total rate 11 7.5) 8.2 1950 (Total rate 128.1) I I I I I 20 30 40 50 60 70 Sources: NCHS, VJt~t Sta is Ice Specie Re#o s--Na ona Summaries, lg50, VOl. 37; NCHS, "Final Morlarity Statistics, 1978 MOt~ hty Vi a ,~ a is cs FCepo , VO 29. No. 6. Supplement 2. September 17, ~9~0 17

F~gure ~0. Trends in Death Rates ~r Suicide. Homicide, and Mofor Vehl¢;e Aec~enfs Among Adoteseent Males. ~y Color: Selected Years, 1ggo-197g lS.24 year old males, Whl~e and No~thlt e Rate per 100J~0 ~p~atlon I00 MOtDf veh~cl~ a~ldgnts (White) Homicide (N~.Whlte) Mo,o,..,o,° 40 . % ~ ~ ~ a0ci~ts (Non.Wh41e) ~0 ~ $ulOde(Whlte) ~" ~ ~ ~ n Suicide (Non ~A~it el I ~ ~ ~ ~ ht~lcide ~Vhite~ 101 I I I I I I 1950 1955 1960 ~965 1970 1975 1~0 Death rates from motor vehicle accidents, homicide, and suicide differ by sex and race among adol~ents and young adults (Figures 10 and H), For white males, motor vehicle death rates have risen since 1960. except for a small dip between 19"73 and 1975 attribulable to enforce- ment of lower speed limits during the gasoline shortage. For other males, the drop in motor vehl- ¢1¢ accidents t'rom 197~ to 1975 was marc pro- nounced. In t97B motor vehlcle accident deaths among 15 to 24-year-old white malts outnumbered suicides by four to one and homicides by six to one. H0w- ever, since the middle 19a0s. horoicldedeath rae~ among non-white males 1 ~ to 24 years old have ex- ceeded death ratea from motor vehicle accidents. Fortunately, the homicide death rates for non- white young males have £a[ien hy 28 Ix'reent slncc 1~70. Homigldt death rates among white males from I~ to 24 years of age have iner e~L~ed sharply since 1955, but still represent only about one fifth the hornlcidt death rate for non-white males in the same age group. Whites have no~ yet experience0 the same recent drop as non-white~ i, homicide death rates among young males in this age group. White mal*s have higher r~te$ of death from suicide than do non-whlte males, and ~the dlspariW hetween these rates has been ~aere~ing.

Among 15 to 24-year-old females, the overall I97g death rate was only about one third that of Illalc~. Similarly. the rate of death from molor ve]~icle accidents for fenlales was about a third the rate for male~, and from homicide and suicide. abo~I one fourth thc rate for male~ (FJgtlrc ll), 13ecausc many habits and lifestyle p~tttcrns evi dcnt in young adults carry over into ]ater adult life. and may have pronounced imp]ications for future health, much efforl ha~ been directed towa~'d prevention of les~ desirable habits and pat terns, Smoking and a]cohol consumplior~ arc two or t~e m(lst prominent target are~. Figure 11. Trends in Death Rates for Suicide, Homicide. ai~ Motor Vehicle Accidents Among Adolesc~'nt Females, By Color: ~,elected Years, 1950-1978 ~5-24 year old females, WhFttJ and Non.While Rate per 100,000 population ~00 5O 4O 30 2O Note: The sel~Cte~ years are 1950, 1955, 1~60, 1~5. 1970, 1975, and 1978 Sources: NCHS Vital Rtati~tJe~ of th~ US, Votume II, Mo~alffy, Selected Years, published and unpublished data. Molor vehicle ~ acci~/ents ~hltel ~. ~" ~ HomicF~e (Nor~White) • ~ Motor vehicle ~, ~,~ ~ ~' accident ~ {Non,WhiteI 10 Hor~¢~ IW~I

k _..J ~od I~;~; ~3HHS, Nalio~¢ Cie~tin~Jhou se Cr~ $rr,~k~n~ a~d HeaCth, C~¢tob~ I~ it~dicate a substantial reduction between 1974 and 1979. The ~ole exception ~ that of 17 to lg year- old fetasles~ for whom the proportion ¢',lrrently smokh~g remained the ~ame between 1974 and 1979 (F{gur¢ 12), The large drop in smoking for younger females (15 to 16-yea~'-olds'l and ma~e~ in f~oth age groups may attest to the effectiveness of the educational campaign to warn youths of the danger~ of smoking.

Cigarette smoking has al~o decllned recenlly among young adults 20 to 24 years old (Figure 13)• De¢[inc~ ~n the p~r~nt and the population cur- rently smoking are large For each group with the cxce]~tion of white femal~ for whom the 1976 and 1978 Surveys showed no change for currcn[ smokers and a slight decline for former smokers. Reduction~ in smoking among non whites are at- tributable not only to a decrease in the number of individuals taking up the habit but also to an in- crease in the number of those giving it Up. Current Fof~er Current Fo~Tner Current Former Smoker Smoker SmOker Smoker Smoker Smoker 1965 1965 1976 1976 1978 1978 $~urues; NCH~,, Oata for Heai~h inie~iew SuPtey, ~tterns ond p~valettc~ of Te~,n~ge Cig~reffe ,~rnokmg 1~, 7~ ?d, I~) Z~', ~n# tQ74; D~HS, N~on~l CP~r~r~ghou~ nn Smok~ ~d H~e!!h Oc!Oh~,r !Q~jO 21

243.8 Car~cer AcOdents 3 4~.g 4 51.8 gt¢ok~ ~.9 C)rrho$1s Of liver per~er~t~ge of total raort[lllty rate shown In blr. 5 ~3'9 perce~t 20.7 [~ 1978 (TOtal rata 5~7.[~I g {~l p~cent 12 4 ~ 1950 (Total tare 6~7.1) 0 =~o 100 150 209 280 Sources: NCHS, Vital Statisttc~--~pfciat Report~--NRtiot~al Summaries, 1950, VOL 37; NCHS, "Final ld or~ aiily Staltstle~, t9?6,'¸ Monfhty Vffa[ ~taffstfc$ Ro~oet, Vot, 2<J. NO. (~, Supl)(ement 2, Septemt~et ~7, 1~. Healthier Adults Until recently, the three leading cause~ of death among adults aged 25 to 64 were heart dJsea~¢, cancer, azld stroke, However, ag dc~crlbcd il~ Chapter l, stroke and/mart d}sca~e mortality rates have been det;lirt~ng since 1950--at redt~cdon in dealh rates s[l~c~ then of 33 per¢ct~t for heart disease and 57 percent for stroke (Figure I4). Dur- ing this same period, cancer dealh rates increased I 1 percent; accidental death rates fell 17 percent; and death rate~ attributed to cirrhosis of the liver increased by 87 percent, As a result, accidents have become the third leading cause of mortality for this age group. In fact. st[oke now ranks only slightly ahead of cirrhosis, the fifth-ranking cause of death for adults. 22 I

lleart disea~¢ death rates for non-white women are nearly twice those for white women, although rates for both groups are declining (Figure 15). Among men the rates direr hetw~n race~ less dramat~eall% but aggregate male dealh rates from heart disease are three times those for women (Figure ]b). For stroke, large differences are associated with race, with non-whites having death rates up to 2.5 times those for whites. The differences between death rates for men and women are small, but consistent, with women having the lower rates of death from stroke. Prevention activities likely to result in further decreases in heart disease and stroke prevalence are those related to risk factor reduction (smok- ing. diet, physical activity, and obesity) and con trol of high blood pressure. At the same lime. medical technology should continue to reduce the mortality rate~ for those already affected by the diseam. Figure 15. Trends #n Death Rates for Heart Disease and StrOke Among Adult Females, By COfO~ Selected Years, 19£0-1978 ¢la~B per 100,000 population 400 - 2t~s4 y~r Old fem$1o$. White ar~ Non.White 2OO ~ {Non whir el 1950 Stroke (Non-WhiteI 100 Stroke 0Nhite) I I I I I I 1955 1969 1965 1970 1975 lg~0 Note: The selected years are 1950, 1955, 19~J, 1965, 1970, 1975, an~ 1978, Soorces: NCHS, Health, Umted State~. 1980, December, 1~0; NCHS, "Final Mortality Statistics, 1978," Month/y Vital ~tat~tic$ P¢*lo or t, VOL 29, NO. 6, SVp Dle,P'len I 2. SeDIeCilber 17, 19B0. 23

Figure 16. Tror~ds In Death Rates for Heart D]sa=ase and Stroke Among Adult Males, By Color: Selected Years. 1950-1978 Rate per 100,000 population 25,64 year old males - White and Non.White d~' ~l~ ~ I~ ~ ~ ~ m ~ ~" ~ ~ m ~ ~ ~ ~ ~. Hea~ di~15~ .3001 ~ (Non-Wt~tel Hea~ dr~as~ 5~ 4O 30 2O 10 5 4 3 2 I I i I ~950 195~ 19~0 ~P65 1970 PJ,~t~,: The selecf~'d years a~'e 19F,0, 1~55, f960, ~&55, 197cj, 1975, an~i 1978. I I ~975 ?980 (Non-White) Stroke ~/Vh~le) 2~

Cancers are the second leading cause of death for adults. The 1969 t977 trends in cancer inci- dence at selected body kites vary for white males and females, depending upon the affected organ. Because of the limited geographic coverage of the DHHS surveillance system, national incidence rates have been estimated only since 1969 for the white population and since 1974 for blacks (Figure ]7). Reliable mortality data for cancers before this period do exist. For whites there are substantial in- creases in lung cancer among femalc~, reflecting increased smoking by women (Figure 18). Cancer of the cervix declined between 1969 and 1977. while cancer of the uterine corpus increased. Co- lon cancer incidence rates have remained relatively stable for both male~ and females. Though some gains have been made with respect to treatment of certain cancers, prevention must be a major component of any broad strategy. Because of the long time periods over which cancer develops, the results of these prevention ef- forts may not be reFIected immedlateiy in declin- ing death or incidence rates. Figure 1Z Age.Adjusted Cancer Death Rates for MaTes. By Site and Race: Selected Years, 1967-1977 Rt~te pQr 100,~90 I~*pulatlon 90 8O 70 6O 50 4O 30 20 10 Black *~ Lung -- m ~ ~ White ~ ~ -- ~ ~ m Prostate ~m m~ ~,~,~~m~mu~ Proslate Int~sfine~ ~nlestlnes Bla~der I I t I I I I T 1 129 1970 1971 1972 1973 1974 1975 1976 1977 Not es: The selected years are 1~9, 1970, 1971. 1973, 1974, 1975. 1976, and 1977, Age-adjusled to 1970 U.S popuMli~. Source: Nat;ona~ Cancer tnstitute. October 1~ 25

i Figure 18. Age.Adjusted Cancer Death Rates for Females, By ~;Ite and Race: ~tected Yeats, 19S7-1977 Rate per 100,000 population 3O ~rea~ 1t-- /,.__------ ~--"'~. _~. /," m m ~ BIBGk ~* L~lng I I I I 1 L I I I lg72 1~73 lg~ 1975 lg7~ 1977 Notes: The 5elecled years are 1g~9, lgTO, 1971, 1973, 1974 1¢375, 1g76, a~d 19TT Aq~adiu~ed to 1970 U S poDul~(or~ Source: N~tlonal C~n~er InsLIt ut e, October, 19~0

Among both adults and younger people, alco- hol abuse and alcoholism are associated with large numbers of preventable ilIne~es, injuries, and deaths, According to the NationaI Institute on Alcohol Abuse and Alcoholism, 10 percent of adults who drink can be classified as problem drinker~. Another 26 percent are reported as hay ing potential problems. The public health conse- quences of problem drinking include injuries and deaths from fails; violence; industrial and motor vehicle accidents; and medical and psychosoeiaI damage such a~ cirrhosis (the fifth leading cause of death among adults), of which more than 90 percenl is associated wilh excessive use of alcohol; pancreafitis; nutritional deficiencies; cancer; and fetal alcohol syndrome. Since 1950, there have been significant trends in three select ed mortality rates associated with alco- holism and alcohol abuse (Figure 19). The ~otal cirrhosis dealh rate increased by 37 percent from 1960 to 1970, gradually leveled off, then decreased 10 percent between 1973 and 1977. Deaths related to alcoholic psychosis and alcoholism increased between 1969 and 1970, when alcoholic psychosis began to decrease despite a slighL continuous in- crease in aleohoIism deaths. Figure 19. Trends in Selectod Alcohol-Associated Caus@s of Death: 1949,19;'8 Raie Pet 100,000 Populatlofl 160 14 0 ~ Cirrh°sis 120 100 8O 4~0 2 0 ~ AIc°h°l~sm -- -- AicohoIFc PsychOSis 0 T~ L-- i ~ i i • i 1S50 1955 1960 1965 1970 1975 7? 79 Sources! Nat i~J nal inslbtute on Aleohol Abuse and Aic0hollsm and N~onal Center for He~ttb Stat~l~c~ Oc~ol)er ~g~0~ 27

Figure 20. Trends In ADparent Per ~Cspita Ethanol Consumption, Based on Beve~ge Sales: 1944.1978 Gallon~ Per P@rso~' .! T°ta~ 24 22 20 18 1,4 Beer 1 O Spirit ~ 0.8 0.~ 04 Wine 1945 1950 1955 1960 19~5 1970 1975 Source~ K~tIe~ at~d Gur/oli~ IR~ige r~ Cetlter or ,~lcotlol S~udie~ 1 ~'~0~ A[coho[ consumption rose 30 percent du ring the 1960s, leveled o~f through most of the ]gT0s, then increased another S ~ercent by I~?g to 2.82 ga]Ions of ethano[ ]~er year for every /~nlt~d Statc~ resi dent ~ed 14 years or older (Figure 20). In lerms ~f the variou~ beverages cons~mcfl, thi~ amounts to 320 twelve-ounce cans of beer, 12.5 fifth~ of table wine, a~d 10,5 qvarts of dlst~]led s~irlt~ p'r c~¢- ~on. It is 31~o important to note that only 30 p~r- cent of the drinking po~latio~ accounts ~or 80 a~d that 10 peree~t of all drinkers account for ~0 percent of the alcohol consumed in the U~t~d St~t~s. T~e~e Wopo~tJot~ su~c~t that thc mo~t e~- f~tive prevention $~rat~cs may r~ate to redu¢. ing the l]umbcr of light drinker~ who enter the heavy, problem-drinking group and Io preventing the atteI~dant consequences. 2R

Healthier Older Adults Between 1950 and I978, there have been sub- stantial shifts in the rankings of the leading causes of death among those aged 65 and over (Figure 21). Although heart disease remains clearly the predominant cause of death, death rate~ have fal- len nearly 20 percent for this condition. Because o[" the large decrease in stroke death rates and the small, but consistenL increase in mortality rates for cancers, cancer death rates now lead those for stroke. Flgun~ 21. Major Causes of Older Adutt Deeths: 1950 and 1978 Age group 65 years and 0vtr Rank Heart disease Rite per 100,0~} popolmtlon Ca~c~ 2 L 18.9 percent li~2o 2~1.1 2061.9 $trok8 ~'~ 1.8 PeTcent I 622.0 Influenza and pneumonia 4 3.6 p,L'rcertt 193.2 6 ~:r¢°nt 191,3 Ar t eelo$cl~r osI5 5 ~2 per'cent 1150 4 ~r~nt 234,9 I I percentage of total mortality rate show~ in bar, r~j 1978 {Total rate 5293.5) ~1950 (Total rate 6270.5) I I [ [ T 1000 1500 2000 2500 3000 Sources: NCHS, Vifai StaIisfics--~Pecmi Reporf~--Nafio~a; ~umnlerie$, t '~Q, VOL 37; NCHS, "Fina; Morta;iW SIa6stics. 1978" Month/,/ Vitat Statistics Report, Vol. 29, NO. 0, Sup01ement 2, September ~7, 19~0. 29

Fiqure 22, Trends in Death Rates for Pneumonia and Influenza Amor~ Older Adults: Selected Years, ~950-1978 f~ale per 100,1~ ~o~)ul~lon 400 ~ yeaTS |nd <pver ~ ~'~ p~eumonia 5O ,m 2D 10 5 4 3 //'/%%% 1950 Intluenz~ , I I I I I I 1955 lg60 1~5 1970 1975 12 Hole: The selected years are ~950, ~955, ~9~, ~g65,1970. lgTS, ~nd 19T6. Source~: N[~)~ ~; ~tat S~ties of fhe U.~ , VOlume II, Mor~lily, ~el~c~e6 Y~rs, publlshe~ and ~ubflshed dat& Though Ih~ overall des(h Tare For intlue,za End pneumonia combined has not ch~.~ged signifi- cantly, the i~ol~Iec~ r~te [or ~nfiucnT~ dc~th~ ~mo~g olde~ ~dul~ has followed a declining. th~h e~rati¢, tTend ~Fig~r¢ 22). The r~¢ of death from pnc~tnonia ~ncrea~cd sharply between 1~5 a~d ~, bu~ h~$ decreased slightly since then. The availa~lhy o~ ~ v~ccin~ ~o~ p~umo,la may yield ~ further decrease in deaths from thi~ cause in the 19gO~ for ol~r adults. W~I~ d~ath ~a~ for old~r adul~ ~m~in a p~- orlty concern, p~rh~s ~he dominant goal relates to improving th~ quality of llf¢ ~.mon g the ~erly. Tv:o {ndieators o~ the extent to which hea[t h pr~h lcm~ J~bh quality of li~c arc ~hc nurnhe~ o~ days that ~tivity is Testr~cted because of health p~'~- Icm~ ~,d the ,umbc~ of bed disability days (]?iguT¢ 23). ~tric~ ~¢~ivi~y days, m~sure~d ~hro~gh the Health Ih~vJcw S~rve)', ~cpres~nl days for which ~hose SUl'Veyed reporl~d they were unable to engag~ in their cu~tomaTy activity. ]f ef~ort~ to e~a~c~ ~he acdvi~y lc~ o~ older ~dult~ 8~e ~uco cess~], the definition of c~lstomary actlv[ty ~vill chan$~ and. paradoxically, the number of re~ st~ictcd aetiv{ty days m~y h~cre~s¢. At the same ~me, lhe ~umbcr of bed dis~bilily ~y~ ~hou]d re~ ~pond by cl¢cli~i~g. 3O

Tracking Prevention Progress The goals set forth in Healthy People are quan- Titative measure, of overall progress Thi, prng ress wiI] be achieved filrough reductions in hun- dreds of heaIth status indicators many of which are tracked nationaI[v, others of which are not. An imporlant component of health efforts in Ihe cam ing decade will be improvement of health status surveillance, the cornerstone of effective preven- tlon program management. Unmanaged stress and its associalion with men- tal illness, cardiovascular disease, and violent be- havior represent an important new arca for moni- toring; other indicators, already being monitored, will require larger samples to be of use in planning and evaluating specific interventions. Better mea- sures of morbidity and mortality related to occu- pational and environmental factors will continue to be important needs, Infectious diseases, parti- cularly incidence data, are also now incompletely reported, resulting in an underestimation of their impact on the health and productivity of indivi dual geographic areas and of the Nation as a whole, And improved measures are needed to assess individual behavior. As new data are galhered and new trends become apparent, they will be included in subsequent editions of this ~port. Flgu~ 23. Trends In Restdcled Activity Days and Bed Dlsabgity Days Among Older Adult¢ 1~O-1~JI 13ays per person per year 100 50 ~ Rlmtt~et~ 40 ~ ~lvlty days ~0 5 4 3 ~~d dllmbllgy days I I I ] I I [ I ~ I [ I I I ~ I I I [ I I l 58 60 62 ~4 66 ~,8 70 72 74 76 78 80 Source¸ NCHS, ~:~at a from HeaTth Irlterci~w Sur~tey. 31

Agency Innovations Though participants from many sectors are re- quired to attain our national prevention goals and objectives, an active F~deral contribution is im portant. A dlver~e group of Federal programs ill health, ed~Jc~tlion, ~oelal services, ntttrition. recreation, transporlatlon safety, an¢~ environ- mental proteetlon provide opportunities for pro- rooting health and preventing disease. Wlthln the Department of l-I eaIth and Human Servieesl every agency contains programs wlth major prevention componentsmactlvitles that span a broad range encompassing the direct delivery of ~¢rvices. establishment and enforcement of safety stand- ards, sponsorship of information effort~, bnilding the capacily of other sectors, and basic artd applied reseapch. Moreover, at least 11 other Federal agencies and departments conduct pro- grams that are directly related to national preven- tion and health promotion efforts. This chapter reviews the prevention roles of both DHHS agen- ¢ies and other Federal departments nnd agencies. and provides highlights of some of the prominent recent agency accomplishments in prevention. 33

I Department of Health and Human Services Public Health Service Office of the Assistant Secretary for Health (OASH) The Assistant Secretary for Health and Surgeon General serves as the Nation's chief heahh officer, w~th respoosibli~ty for ~togram~ and policies related to health services delivery, dlscase prevention and h~alth promotion, and biomedical r~earch. OASH Prevention Highlights Htalthy People -- The Surgeon General's Report on Health Promotion and Disease Prevention. The major conceptual document for the national prevention initiative. Hea/thy .oeo~,~e. de~crthe3 this country's achievement~ and opportunitie~ in preventlon, notes major health problems for five principal age groups. and sets a measurable health goal to be achieved for each group by 1990. For infants, special at tentlon is given to low birth weight arid birth defects; for children, growth and developmental problems and accidental injuries; for adolescents and young adults, alcohol and drug misuse and motor vehicle aeeidetlts; for adults, heart disease. ~toke. and can~er; for older adu~, issues of dependency and faflucrzza and pneumonia. The report al~o identifies 15 prior ity at:tlon areas crucial to Dfcventlng these health problems arid achieving the goals of the report. Measurable Prevention ObJectivex for 1990. Based on the framework of Healthy Pea pie, 226 measurable prevention objectives to be achieved by 1990 have been developed for the 13 priority activity area~. These include: h;~h blood pressure control, family planning, pregnancy and infartt health, immunization, sexu- ally transmitted diseases, toxic agent eontrbi, occupational safety and health, accident preven- tion and injury control, fluoridation and dental health, surveillance and control of infectious diseases. ~moking and health, misuse of alcohol and drug~¢, 0utrition, physical fitness and exer- cise, and contrbi of stre~ and vlolez~t behavior. For each area. specific objectives are identified with respect to improved health status~ reduced risk factors, increased public/professional awareness, improved servlces/protection, and improved surveiHanee/evalttation systems. In developing Promoting Health~Preventing Disease: Objectives for the Nation, DHHS has drawn upon the expertise of over 500 in- dividuals from the public and prlvatt sectors: all agencies of the Department. other Federal ager~zies and deoartments. State arid local heMlh agencies, consumer groups, voluntary organiza- tions, and academl¢ leaders and other health professionals. National Toxicology Program (NTP), Established in FY 1979, the NTP addresses the prevention of environmental he~alth hazards through better coordination between scientific institutes and regulatory agencies. DHHS is working through the NTP to strengthen efforts to test toxic vhemicat~ and to develop attd validate better testing methods. Membership in this interagency prngrara includes the Food alld Dtng Administration, the National Institute for Occupational Safety and Health in the Centsr for Disease Coatral, the National Cancer In- stitute and the National Institute of En- vironmental Health Sciences in the National In- stitutes of Health, the Office of the Assistant Secretary for Health. the Occupational Safety and Health Administration in the Department of L~bor, the Consumer Product Safe~y CommJso sion, and the Environmental Protection Agency. Through this program, DHHS plans to test 100 n~w chemicals for carclnogenlefty each year. Agencies outside DHHS provide advice on

which compounds should be tested. The list of substances to he tested for teratogenicity and mutagenicity ix currently being developed. Report on the Health Status and Problems ef Women. The Office of the Assistant Secretary for Health developed a comprehensive paper that identifies and discusses major health issues specific to women in the United States. The paper, prepared for the United Nations Mid Decade Conference on Women, was published in October lgg0. It will asslst the Department in identifying important health problems of American women and possible approaches to prevention. Notable emphasis in this paper is given to breast cancer the leading cause of cancer death for women. One in 13 women in the United States develops breast cancer; early detection eouId decrease the number of deaths from this cause. Other issues addressed include health problems associated with increasing lung cancer incidence, menopause and aging, depre$ sion, stress, substance abuse, family planning. pregnancy, and chddhirlh. Office of Disease Prevention and Health Promotion The Office of Disease Prevention and Heahh Promotion (ODPHP) was established to coor- dinate policy and program development in prevenfion. Examples of its activities include operation of the Departmental Task Force on ~rnnkino ~nd l-le.~!th~ ~ncl the T~d" Force on Prevention, as well as coordination of the preparation of Heel[by People and the ObTec- liver for the Nation. In addition, the ODPHP sponsors innovative programs related to health promotion. Office of Health Information. Health Promotion, and Physical Fitness and Sports Medicine (OHP) The Office of HeaIth Information. Health Pro- motion, and Physical Fitness and Sports Medicine was created in 1976 to deveIop and coordinate programs related to these health are&s. Working with government agencies and private organizations, OHP attempts to stlmulate health promotion efforts in schools and corn munities, at worksites, and at medical treat- ment facilities. Through OHP a National Health Information Clearinghouse has been established to facilitate access of consumers and health pro- fessionals to a wide range of health information reF.onrces. OHP Prevention Highlights Regional Forums on Community Health Promotion. Eight Regional Forums on Cum- munity Health Promotion were sponsored by OHP in I979 to encourage business, labor. health educators, med[a~ and civic leaders to organize resources in their own communities for health promotion programs. More than 2,000 local representatives and Federal of EeiaIs shared concerns, priorities, and resources. A final pubIication released in 1980, Promoting Health: A Source Book. describes several local initiatives and provides a resource guide for local health promotion program leaders. National Conference on Health Promotion Programs in Occupational Settings. The worksite provides an excellent opportunity for organizing health promotion programs and health servia. OH]~ delivering "~" !. first National Conference On H i Programs in Occupational Stnin~ " 19~;~ tended hy representatives of indusb3t~.~ insurance carriers, and mem~mt:-~t'~J~ academic/scientific community,t~ " -~the " ~, identified model programs and ~al~.=t~"~ development of programs at the ~tlite~: assist the people in improvln follow-up to the OHP has worked with industr sector organizations to develop worksite health promotion establish a common data ha~ for t~ evaluation in programs in seversl NafionBI ComfereDee on School H with the Bureau of Health E of Comprehensive Schc~l Health in ment of Education, and selected health tional conference on motlng Health Throug] merof 1 integrating school health st~vic~ wlt~ health education programs, bast~l On lions of model programs in both m.~t~$. foIiowing this conference was hekl.~t~ 1980 to identify national health q to set national, State, loca , , . , -t. organlzatnons that may contribute to ~; ins the objectives', and to advi~ OHP a~ t ~. erat implementation strateg,,,. .~,.: HEalthWorks. In May of 1999 the OF~ c0- sponsored HEalthWorks, an outdoor h~tltb fm~ held in Washington, D.C., to serve as a mod~ for

communities throughout the country in using cre- ative r~ethod~ to provide ~nformadon about healthful living. Toward a Healthy CommuniLv, a two-volume manual, was pubfished to describe the heahh fair and in suggest ways in wfl~eh commuu~ des can use similar events as vehicles for generat- ing media attention to health promotion and for cncouraglng cooperation among community agencies. Mi.orily Group Health Promotion. The OHP is developing a mechanism to increase involve- ment of mlnor~fy groups in the development of na- tional heahh promotion/prevention policy. As an initial step toward this goal. a series of five one- day workshops addressing the health priorities of Native Americans and Asian, Black, Hispanic. and elderly Americans was held in Washington, D.C.. during May 1980. The recommendations of these workshops are included in the summary re~ port and proceedings. Community Technical Assistance Projects. Throughout the country, communities are devel oping, impietnenting, or expanding innovative programs among various population groups to help people reduce health risks through changes in personal habits. On a pilot basis OHP has pro- vidcd technical assistance to 17 communities rep- resenting a cross-section of the country, ranging from the Riverside County Health Department in Cabfor~a to Appalachlan Leadership and Out- reach, Inc., in eastern Kentucky, to the Baltimore City/County lqeahh Department. A second tech- nical a~stance project, designed tn dncnment the experience of f;ve eommnnlties through case studies, is also being conducted by OHP. A guide for other communities interested in thitiallng a health promotion program will he prepared, based on the~e projects. 36 HEALTHSTYLE Campaign. In 1980 OHP ini- l~aled a nallonwide carapa~gn to educate the ptlb- lic about the relative risks to their health of certain behaviors. The major area!; addressed by the cam- paign are smoking, alcohol and drug misuse, stress, nutrition, exercise, and safety. A HEALTHSTYLE self-test was developed for dis tribution throughout the country to help indivi- duals assess the relative risks to their health and to encouro, ge them to reduce those risks. The efforl includes television and radio public service announcements in English and Spanish. and com- munity health organizations have been enlisted in nine test cities across the United States to aid in the effort to disseminate information materials. The intermediary role includes distribution of posters, booklets such as Toward a Healthy Com- munit3; print ads, HEALTHSTYLE brochures. and transit cards, as well as referral of individuals to sources of help in reducing risks to their health and evaluation of the effectiveness of the cam paign. Nutrition Coordinating Committee (NCC) The Department's Nutrition Coordinating Committee (NCC) is responsible for enhancing communication among agencies on the Depart- ment's many activities in llutrition and for work- ing with food industry and professional nutrltion societies on nutrition policy issues of mutual in* terest. Standing subcommittees have been formed to facgitate collaboration in six areas of nutrition: education, research and training, services, nutri- llon status monitoring, food saf~y and qua0ty, and international nutrition. NCC Prevention Highlights Conference on Nulrllion Education. The Na- tional Conference on Nutrition Education, spon- sored by the I)¢partmenl of ~[eahh &nd [4uman Servie~ in conjunction with the Departmen~ of Agrienllure, the Veder~tl Trade Commission, the White House Office of Science and Technology Policy, and the Society for Nutrition Education, was convened in September 1979. The focus of the conference was the nugritlon education need~ of the general population and, in particular, preg- nant ',vomerL chi/dren, adole~ornts, /ow-lncom~ populations, the elderly, and persons with diet-re luted diseases. Options and priorities for nutrition education were re¢omrtlended. The proceedings of the conference were published as a ~npplement to the Journal of Nutrition Education. Dietary Guidelines for Americans. In January 1980, the Depot tmenl of Health and Human Serv- ices and the Department of Agriculture joi.dy issued a set of d~etary guidelines entitled Nutrition and Your Hearth. These guidelines were intended to assist generally healthy people in selecting a basic, balanced diet for maintaining normal weight alad good health. Seven rules arc suggested, including advice on which foods to eat and which to avoid. Over 5 m~lgon copies of the guidelines have been distributed to the public. Office of Management The Pt~esident's Council on Physical Fitness and Sports (PCPFS) The PCPFS was established in 1956 as the President's Council on Youth Fitness, and its responsibilities were expanded to include the

adult population in I963. The agency works with State and Iocal governments, schools and coIieges, professfona[ associations, sports organlzatlon~ and the private sector to promote particlpation in exercise and sports. Specific programs include technical assistance to various organizations, pnbllc servlce campaigns, pro- moting I~hysical actlvity, regional leadershit: training workshops, awards to youth for outstandlng physical achievement, and publlca lion of research infcrmatfon. In 1980, the Presi- dent instructed the PCPFS to concentrate on promoting dally physical education programs in the schools; establishing Governor's Councils on Physical Fitness and Sports in all 50 States: urging ¢ltlpioyers Io establish employee fitness programs; and encouraging all Federal depart- ments and agencies to support physical fitness programs for their personnel. PCPFS Prevention Highlights National Conference on Physical Fitness and Sports for All. The National Conference on Physical Fitness and Sports for All, cospon- sored in February 1980 with the OHP and the Department of Education, provided a forum for reviewing and discussing the central physical fitness issues for all age groups. The conference focused on exchanging empirical information on ph~ical fitness practices and programs, examin- ing the application of research findings to pro- grams, and exploring the concept of sports for all. The proceedings of the conference are available. White House Symposium on Physical Fitness and Sports Medicine. In October 1980, the PCPFS cosponsored with the White House, the OHP, Ihe American Medical Associatlon and the U.S. Department of Defense a symposium on preven- ting and treating injuries caused by vigorous sports and exercise. Physicians, other health pro- ~essionals, and physical fitness and sports experts presented information about preventive leeh- niques and proper equipment. More than 300 members and students of the health and sports professions attended the two day symposlum. Office on Smoking and Health (OSH) The long range goal of the Office on Smoking and Health (OSH) is to reduce deaths, disabilities, and health care costs associated with cigarette smoking. TO accomplish this goal, the OSH spon- sors programs designed to provide in format ion on the prevalence of smoking and associated at- titudinal, epldemiolngic and economic factors; reduce the number of women who smoke and are pregnant, take oral contraceptives, or have in creased risk of disea.';e because of other factors; reduce the number of children and adolescents who smoke; reduce smoking among persons ex- posed to occupational health hazards, including asbestos; and reduce smoking in racial and ethnic minorities. OSH Prevention Highlights 1979 Surgeon General's Report on Smoking and Health. In 1979 the Office on Smoking and Health completed Smoking and Health: A Report of the Surgeon General, the most comprehensive review to date of research on the health consequences of smoking. The 1979 report also contains informa- tion on new area.s, including health effects, public education, prevention, and public policy. An im- portant focus is that on increased risks to smokers exposed to ccrtain occupational hazards, such as those workers in the asbestos, rubber, coal. tex- tile, uranium, and chemical industries. Also ad- dressed are the effects of smoking on drug responses, nutrition, and diagnostic tests; the ex- cess morbidity and absenteeism among smoking workers; and the special risks for women who smoke. 1980 Surseon General's Report on Smoking and Health. In January 1980, The Heelth Comce- quences of Smoking for Women was released to the public. The report addresses the major health issue of cigarette smoking by women, includes cent data on cigarette consumption, and docu- ments changes in smoking behavior by women. This report establishes that women who smoke en- counter risks similar to those of male smoktxs. Moreover, the report notes that the incidence of lung cancer among women is rising sharply, n result of smoking initiated during and immedi- ately following World War IL New evidence is reviewed on the harm inflicted by cigarette smok- ing during pregnancy on the fetus and newborn baby, and on the special risks of heart attacks for women smokers who also use oral contraceptive. Natfonal PO~ler and E~y Contest. To in- crease awarpness among youth of the health risks of smoking, OSH conducts national poster and essay contests for seventh-graders aero~ the country. In 1979, 18,000 seventhw, raders submitted POSters and essays. The winning posters and essays were shown in a series of ex- hibits throughout the Nation. The winning posters and essays selected from 37,680 sub- mitted in 1980 will be featured in a nationally distributed brochure. 37

National Media Campaign~Evnluation. T~) impress upon teenagers the haT~rds of smoking and it~ impact on health, OSFI initiated ana tlotml med~a campaign in Angust 1979. To achleve its aim. this campaign employed public servi¢~ announcements o~ TV and radio; pro~ gt~Ar~t~ for radio; adver~i~erneflts in journals, tangerines, and school and college newspaper~; p~blie transit and point-of-sale displays; and pamphlels. A formal evaluation of the effec- tivtness of this campaign is under way. Office of Adolescent Pregnancy Programs (OAPP) OAPP was created in 1978 to help establish net- works of cori~munity based cervices for adoles- eclats--those already pregnant or parents as well as those who wish to avoid pregnancy. Every year, one million adolescents become pregnant. OAPP cOOrdinates Federal programs and policies with the aim of reducing the number of unplanned ini- tial and reOeat ndolescent pregnancies. In addi lion, the OAPP gcovides technical asslstanee and administers a grant program for community ado- lescent health pro~ects. OAPP Prevention HighUghts Grant Progtttm. in [978 Congress authorized a grants program in rzspon,;e to the gfowlng aware- ness of the prohlc'n~ of teenage pregnal~ey. Under ~hi~ prog.~m, since 1979. OAPP has awarded $6.4 nfilBon in grants to 27 public or nonprofit private organizations to provide cor~prehensive health, education, and social services to pregnant teens and young parents. Projeetg are now located in 21 State~ arid the District of Columbia. Som~ 38,000 teenagers will benefit from a wide range of serv- ices including pr¢- and postnatal care. infant day care, lraining in lxarentlng skills, vocational education and job training, social xervlces, family planning, and education in sexuaUty and family Iife. Grantees make maximum use of ~xisling pro- grams and seek to bring {ogether Federal, State. and offence ~ector fund~ ~n ~;upoor¢ of Ihes¢ T~:hnlcal As~istan~e Workshops. In 1980 OAPP initiated a series of technical assistatice workshops to he held throughonl the ldnited Slates in ordtr to ~hare ideas about comprehen- sive programming for pregnant adolescents and adolescent pltretlts and to advice prospective grant program appfieanls about funding pro- cedurcs and reqtl~remellts. Office of Population Affairs (OPA) The Office of Population Affairs is resl~oi~ sthle for the ova'all planning, dlr~ctJonf coordlr~ado~, monitoring, and evaluation of the population research and Family planning service orograms of- fered by various ageneieg in the Department of Health and Human Services. These programs have been designed to promote the development of healthy families and to prevent the physical, emo- tional, and social dis associated with unp[anlled or unintended pregnarlcies and ~irths, The health implications of ¢ffectlve family planning scrvlc¢~ are significant for certain categories of women, among them 4.9 m~!llox~ t~anngers and 5 million low income women who constitute the priority population served by the programs that OPA oversees. OPA Prevention Highlight~ Sterilization Regulations, OPA has lend responslbiIity within the PHS for dlreedng im- plementation of new regulations governing Federal e~pendit~fes for sleri]izalio~. A~roXi- mately 100,000 sterilizations are fnnded by the Department each year. New rules were pro- mulgated in 1979 to provide greater protectlon against abuse of this fatally planning method in specific eases. OPA h&~ conducted special sterilization education programs to assure that providers and patients are aware of their fights and responsibilities under the new rules. In ad- dition, OPA is conducting an assessment of the effects of the regulatlorls to identify hardships or problems created by specific provisions Evahtatlon of CoutrselP~g in Ftmlly PIIm- aing Programs, OPA has initiated a study of ongoing counseling practices in family planning programs, the results of which will guide policy coneernlng the desirability and fea.sibility of pro- viding counsegng services in addition to infor- mation and education on contraceptive methods. The ptlmary objective of the project is to ascertain whether such sctv/ees pro*Me ar~ effective approach to preventing unintended pregnancies, partleu]arly among the teenage population. Office of Health Research, Statistics, and Technology (OHRST) The Office of Heahh Research, Statistic. and Technology (OFIRST) serves as the principal ad- visor to the Assistant Secretary for Health i~ the areas of health services research, he~.lt~

statistics, and heahh technology asseqslnent. In carrying out its mi~ion, OHRST provides ad- minlstratlve support, programmatic oversight and eoordlnatlon of the activities of the National Centers for Health Services Research (NCHSR), Health Statistics (NCHS). and Health Care Technology (NCHCT). In addition to specific activities that relate to primary prevention objectives, many other ac tivities within the National Centers serve to broaden and enhance our understanding of and ability to assess the prevention efforts of the Department. Included are the baseline and targeted statistical activities of NCHS such as the Health and Nutrition Examination Survey and the Health Interview Survey. as well as the consensus exercises sponsored by the NCHCT. National Center for Health Servlees Research (NCHSR) The National Center for Health Services Research (NCHSR) undertakes and supports research, demonstrations, and evaluations on pro blcms in the organization, delivery, and financing of health care services. It also serves as the focal point for dissemination of heahh services research findings to public and private sector decision- makers, Examples of NCHSR projects include those related to the accessibility, acceptability, planning, organization, distribution, utilization, quality, and financing of health services systems, health manpower, facilities and equipment, and the uses of computer science in health services delivery and medical information systems. NCHSR prevention Highlights NCHSR Solicitation - GranL~ for Re*catch on Health Proraotion and Disease Preven- tion. In August 1980 the National Center for Health Services Research (NCHSR) and the Of- fice of Health Information, Health Promotion. and Physical Fitness and Sports Medicine (OHP) published a grant solicitation on Health Promotion and Disease Prevention. The solicitation encourages research on specific strategies to improve individual health of Americans through the promotion of healthful lifestyles and the prevendon of disease and in- jury. Particular emphasis is placed on the following areas of r~earch: economic, political and social aspects; health education; and set- tings and manpower. Health Hazard/Risk Appraisal Research. NCHSR is supporting efforts to assess existing health hazard/risk appraisal programs. The study characterizes the programs according to sponsor- ship, target populations, program structure and process, cost, and e f fectivene'~. When completed, the study will be for use by State and local health planners, pollcy-makers, and health care profes- sionals. Cosl Models: Cigarette Smoking. NCHSR is supporting the development of cost information related to cigarette smoking to assess the economic impact of various actions to reduce smoking. One study estimates the cost differential of providing medical care to smokers, former smokers, and nonsmokers. A second study appraises the social COsts and benefits of antismoking policies such as smoking bans and media campaigns and their pos- sible effects on tobacco-producing States. A third Study examines the potential for uglng tax revenue to reduce smoking. The study results should be of use to potley-maker~ for planning antismoklng programs. National Center for Health Statistics (NCHS) NCHS is the principal Federal source of health data used in planning health services and other programs that meet the health needs of the Nation. Working with State and local govern- ments, the Center collects and analyzes the vital statistics of the Na(ion and conducts surveys of illness and disability and the use and availability of health services, resources, and manpower. The Center also conducts research on the development and evaluation of data collection systems and trains health administrators and statisticians. NCHS Prevention Highlights Health Practi¢~ Survey. In 1979 NCFL$ and the Office of Health Information, Health Promotion, and Physical Fitness and Spoi'ts Medicine conducted a two-phased national survey to determine the prevalence and slability of health practices. During the f'LOSt phase of the study, approximately 3,009 telephone inter- views representing a national sample Of from 20 to 64 years of age were ¢on~ d~- [ng spring and summer 1979. Rcspondtmtg wea'e interviewed again in 1980 with ~ the same questionnaire. The re'suits will ~ I~'or- matiun on the dL, itibudon mad ~Of /a~,~ habit~, the relationships bctwc~m htt[l~ ltaMts and health status, and the changes over time. " - :~ 39

Publl¢ Health Conference OR Rccord~ ~;nd Statistics. NCHS provldes support to the bien- nial Public Health Conference on Records and Statistics. The August 1980 conference em- phasized applications and uses of records and statistics in the areas of environmental and oc- cupational health and health promotion efforts. Se&*ions were held on such topics as ailai re~ords, health promotion, anti lifestyle fuetors; use of health records in health promotion ef- forts: statisticaI approaches to health promo- tion; and cost and benefits of prevention. Prevention Profile. Health, United Stat~, 1980, the fifth annual report to Congress on the health status of the Nation, contains a Preven- tion Profile. This profile, required every third year by Section 404 of the Health Services and Centers Amendments of 1978 (Public Law 95-626). provides a data base for assessing the implementation of disease prevention and health promotion programs. Prepared in cooPeration with the Office of Disease Prevention and Health Promotion, the profile offers a mechanism for formally tracking the national measurab/e prevention objectives for 1990. Office of Health Maintenance Organizations (OHMO) The Office of Health Maintenance Organiza- tions offers technical expertise and consultation to individual health rnafutenallce organ/zations ~ tliat they" can better fulfill responsibfiitles to their members by providing health educa6on services, particularly with respect to what each member can contribute to maintaining his own health; information about HMO services anti recommendations on the use of these services; and nutrition education and counseling. OHMO Prevention Higb|Jghts Physician lnvolvemen! in Preventiofl. Through technical assistance provided by OHMO, the Medical Director's Division of the Group Health Association of America, the members of which are prepaid group practice physicians, beg~n to ~hift their mectlng em- phasi5 from administrative topics to a concern for service and prevention. As a re~;ult, the 1979 meeting go;used on prevention of mental illness, the care of chronically ill patients, hOSpitaliza- tion, ~tDd the role of the mental health profession in promoting HMO member health and well- being. The 1980 meeting addressed health pro- motiou and how to traxtslate the current impatus toward promotion activities into effective HMO programs. Preventive Services Demonstrations. With the OHP, the OHMO is cosponsofmg two proj- ~ to d~onstrate the effectiveness of the delivery of health promotion services in a clinical setting. One of these projecL~ assesses the potential for reducing infant mortality by pro- viding HMO-based prenatal counseling for high- risk pregnanaies~ and the other focuses on HMO- hased counseliog on the use of at~to restraints. Office of International Health (O1H) Oill provides leadership, formulates overall policy, arid assures coordination of the Depart- ment's international health actlaid~s. The Office is the official liaisc~,~ agency of the United States in relationships with international health organiza- tions, notably the World Health Organization (WHO) and the Pan American Health Organlza- lion (PAHOL O/H provides overall policy guid- ance in international health and promotes and coordinates participation of the PHS agencies in programs and activities related to hlnationai health relationships with more than 20 countries, OIH Prevention Highlights Collaboration with WHO Chemical Safety Progmam. Efforts were initiated to collaborate with WHO's International Program on Chemical Safety. which is concerned with the evaluation of toxic chemicals in foods, work places, water~ and air. The principal objective is to determine the stage of toai¢ily at which chemicals ave harmful to human health, In the United States. this effort involves NIOSH, FDA. NIEHS. NCI, and EPA. U.S.-P.R.C. Heailh Cooperation. It~itiai work plans were devefuprd for Several Drevention- related aclivltle~ under the Protocol signed in 1979 between the United States and the People's Repablie of China. These plans include, among other activities, cooPeration in new approaches to research on the epidemioiogy anti COtltrOl of io ftu~ enza and exchange of information on the appear- ance of new stralrt$ of influenza virus, parallel investigations into causes of major cancers, and joint studies of incidence and mortality to help aiarify the infiuenge of host and environmental tieterminatnts of cancer. In 1980 the two countries agreed to add three new prevention-related area~ to the program of cooperation--papalation research, mental heahi% and food and drugs, in the last area. for example, the United States is interested in receiving from the People's Republic of China information relating to her program for reporting adverse drug reaction.

U.S.-lndla Health Cooperation, In I9g0 agree- me~t was reached between United States and In- dian health officials on expanding lhe program of health cooperation to include research directed loward preventlon of nutritional blindness and other joint nutrition activities, such as United States Indian workshops on evaluation Of the nutritional status of the individual and of the nmritional effects of gastrolntestina[ infection. Cooperation is also being expanded in the field of reproduetlve physiology Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) The Alcohol, Drug Abuse, and Mental Health Administration is the Federal agency specifically mandated to prevent and reduce alcohol abuse and alcoholism, drug abuse, and mental and emotional illness. ADAMHA conducts and sup ports research into the causes of these diseases and disorders and develops new approaches for prevention and treatment. It finances training programs and supports a wide range of treat- ment and prevention activities in community centers. In 1979 prevention was e~tablished &¢ the agency's fourth major priority, along with research, training, and treatment services. ADAMHA Prevention Highlights prevention Division Established. The Of- fice of the Administrator was reorganized in 1979 to establish a Division of Prevention within the new Office of Program Planning and Coordination. The Division coordinates all ADAMHA prevention activities, espealal[y those of a cross-cutting nature. Working in con cert with the NIAAA, NIDA, and NIMH, in 1979 the Division evolved a comprehensive long-range prevention policy for the agency through an in depth examination of all ADAMHA prevention activities and related policies, with emphasis on those involving all three Institutes. National Conference on Prevention. A na- tional conference sponsored by ADAMHA was held in September 1979 to review identified prevention policy issues and to discuss preven- tion programming in the alcoholism, drug abuse, and mental health fields. The mcetlng was organized around three major themes: health promotion and disease prevention--oppor- tuniti~ and challenges; commonalities in ADM prevention programs for children and youth; and mulfieultural approaches in alcohol, drug abuse, and mental health prevention programs. The sec- ond national ADAMHA conference on preven- tion is scheduled to focus on ADM prevention at the worksite. Project Sleep: National Program on In- somnia and Sleep Disorders. Two reports, one by the National Institute on Drug Abuse in 1977 and another by the Institute of Medicine of the National Academy of Sciences in 1979. recommended that the Federal government undertake an education program to improve physician and patient knowledge and practice in the use and misuse of sedatlve-hypnotic drugs and about the diagnosis and treatment of sleep disorders. In December 1979 the Surgeon Genera] announced a three-year education and research program, Project Sleep, incIudlng state-of-the art and scientific consensus development conferences; additional research; 41

development of medical schoo~ curricula; materials for continuing medical education; a Surgeon Oenerel's Advisory on the u~ of hyp- notic drugs; patient brochures containing the ]ates~ medlca~ion information for di~rihutlof~ ~ d~ctors' offiee~ and pbarmacles, and dissen~ina- tlon af information to the general publlc. National Institute on Alcohol Abuse and Alcoholism (NIAAA) The long-range goal of the NalionM lnslitute on Alcohol Abuse and Alcoholism (NIAAA) is prevention of aIcoholism through effective pro- grams, including public education about the ~ubtie health aspects of aIcohol use. A short- term ~oal is the provisiot~ of quality treatment and rehabilitation services in communities. NIAAA stJppotts research, trainirlg, and educa tlon programs designed to identify causes of alcohol problems and methods to prevent or treat alcoholism. The Institute's major facility for collecting and dls~eminating data is the Na- tional Clearinghouse for Alcohol Information (NCALI). NIAAA prevention Highlight~ NIAAA Public Education Campaign* In 1977 NIAAA developed a media/evaluation program to create, disseminate, and assess the effect of materials bearing on alcohol problems, including the effects of alcohol on fetuses. These materials were directed tt~ward women of ¢Midbearing age and youlb, in ar~ effort lo in- fluence their behavior related to drinking while driving. EIemerits of the program include probtem analysis, audiel~ce assessment, development and testing of Concepts and messages, and the prodoc 42 lion of media materials for television and publica- tion. The Institute i~ now evaltladng bow Ihe maler~al$ affect target audiences and the dls~emination methods used. gympoglum on State Drinking P*ge Laws. Rccqt~tly a tltttrlbcr of Slates bare' raised, or con- sidered raising, the legal drinkiug age. To ex- plore the potential effec'Ls of changes in drlnklrlg age laws, to review CUtTCnt information o~1 the subject, and to recommend directions for future research and action, NIAAA and the Medical Foundation cospor~ored by 1979 a multldlsei- plir~ry ~yrapo~ium on d~inklng-aga ~aws. Another NIAAA symposium examined the ~uhjeet of children of aleohoflc parents. "Here's Looking At You" Curriculura. Sponsored by NIAAA, the King County. Washington, Alcohol Education Curriculum Proje¢l .o~odu~ed a Beld-le~tgd school ~urrlculum [or Grades kindergarten through 12, to be used alone or integrated with existing currlcula. The program includes a detailed teacher's guide, Here's Loo~ing At YOU, and accompanying kits for each grade level coatainlng films, charts, in- structional games, and puppets. About 15 hours of dasswork at each grade level are outlined in the teacher's manual. The currlculum em- pga~izes prltnary preyenfion and eorr~birles alcohol Information with exercises designed to entianee coping and deeislonLmakittg skills together with clarification of values and at- tiludes. Prevelltiola Model Reglicalion Pr*Jgeall~. NIAAA's Division of Prevention is implementing a plan to replicate three alcohol abuse preven- tlo~ models directed toward youth, b~scd on the results o~ three-year demonstration granl~ funded by N1AAA% Youth Education Branch. The three prevention models are the University of Massachusett~ Alcohol Education Project in Amherst; the King County. Washirtgton. ESD #121 Alcohol Education Curriculum Project; and the CASEAR Alcohol Education Program of Somer~'il~e~ Ma~acht~etts. Under thi~ replica~ tion program, eight Slate alcoholisro program~ have been seleelcd, through the grant mechanism, to work with NIAAA in field testing the adapt- ability and replicabilily of the three original modds. The finding~ from thi~ replication effort will determine Iuture dissemination of the ~'or kbooks a~d ~formador~ about addti~or/a~ pro grams. Prevention Publlcatlons. In 1979 the NIAAA published a compilation of alcohol~m- prevention literature entitled Alcoholism pre- vention Guide to Resources tend References. A~ a coutributlon to the lnterllatior~al Year of the Child. NIAAA published a booklet, /s Beer a F6,ur-Letter Ward?, eon~istlng of s~ggested ac tivities to be implemented by teenagers in their sehool~ and communities. National Institute on Drug Abuse (NIDA) The Natlona[ [l~stitute on Drug Abuse (NIDA) funds local prevention and treatment projects and hal initiated an outreach program. NIDA supports research on the factors that contribute to the misuse of drugs, trains workers in prevea- tion and rchabil]iafion, and e,~plores new ap- proaches to prevention through educafioa. Thc lnstitute's Nadonal Clearlnghottg¢ for Drug Abuse is It center for the collection and dls~eminatiol~ of data about this subject. The

primary goal of NIDA's prevention strategy is to reduce or prevent drug abnse by fostering positive human development. NIDA's short- term program objectives are to develop, demonstrate, and disseminate effective preven- tion strategies and to strengthen State and local capacilies to deliver prevention services. NIDA Prevention Highllght~ Slate Drug Abuse Prevention Grant Pro- gram. Virtually every State and territory now receives a NIDA grant to carry out prevention activities under the State Drug Abuse Preven- tion Grant Program (SPG). In each participating State or territory, a prevention coordinator supervises program planning, implementation, and evaluation. State prevention coordinators provide technical assistance and disseminate prevention materials and techniques to com- munities, and collaborate in establishing a net- work through whleh States can share informa tion and technical assistance. In 1980, the pro- gram was expanded to include a parent/family component, States can now apply for prevention service money to enable them to provide support to communities. The SPG also permits States to appty for support to activities to stimulate pro- grams that stress innovative, cost-effectlve prevention strategies. The Center for Multleulturai Awareness. The Center for Multiculturai Awareness (CMA) responds to the need for developing prevention materials and programs tailored to the needs of e~hRie .rndnor~l.y groups, Thp~@ ar~)ln~ inehlrl@ Asian/Pacific Islanders, Black% Mexican Americans, Indians, and Puerto Ricans. CMA provides technical assistance to single State authorities and American Indian tribal entities, develop~ drug prevention materials, provides translation services, conducts workshops ia multicuhurai drug abuse prevention, and advises NIDA on minority issues and drug abuse prevelt- tion strategies. The National Clearinghouse for Drug Abuse Information disseminates the materials CMA produces. National Drug Abuse Convention Cam- palgn. In 1979 NIDA developed broadcast and print media materlals, including two public in- formation pamphlets--A Woman's Choice: Deciding About Drugs and Say NO: Drug Abuse Prevention Ideas for the Classroom. The latter is intended for seventh and eighth- grade teachers~ both are available from the Na- tional Clearinghouse for Drug Abase Informa- tion. Two television announcements and four radio spots, aimed at youth aged 12 to 14 and women aged 18 to 24. were distributed to State agencies concerned with drug abuse. The~e materials were prepackaged so that States could distribute them to local broadcasters for airing in 1979 and 1980. National Institute of Menial Health (NIMH) The National Institute of Mental Health (NIMH) conducts and supports research into the causes, prevention, and treatment of mental and emotional disorders. Special areas of research are schizophrenia, severe depression, child mental health, mental health as!aects of crime and delinquency, minority group mental health, metropolitan probiems, menial heaith of the aging, and psychopharmacohigy. NIMH trains mental health workers, distributes mental health information, and collects and disseminates relevant statistical data. NIMH Prevention Highlights Prevention Research Funds. In 1980 NIMH committed Sa million for prevention research funds. The Office of Prevention. within the OlX rice of the Director of the Institute. had lead responsibility for planning and implementing the prevention research program. A Prevention Ad- visory Group composed of representatives from all NIMH Divisions provided consultation to the Office of Prevention. A total of 34 research grants, 6 Inleragency Agreements, and 2 con- tracts were supported with these funds. Areas of emphasis included the impact of marital disruption on children, the impact of severely disturbed parents on children, stress, and minorities. Plans for the future extend to in- eluding research projects in the area of high risk depression. Prevention Grants for Child Menial Health. NIMH supported seven grants in FY 19g0 submitted in response to a special an- nouncement for applications in the area of the impact of maritai disruption on children. In addi- tion, six grants were supported to investigate the effect on children of severely disturbed parents. 43

Centers for Disease Control (CDC) The major goal o~t the Centers for Disease Control (CDC) is to lead public health efforts to preven~ unnecessary di~ase, disability. ~tnd d~h. CDC pursues [~is goal lhrough in- termediate oLitcome goals--prevention and con tro[ of infectious disease; prevention of disease, dJsability~ and death associated with e~- vironmental and workplace hazards; prevention and control of chroni~ diseases; and the promo- tion Of health. In addition, CDC pro~id~ sup- port to local, State, ~cadcmic, national, and in- ternational effort~ in dlseipllnes basic to prev~n- tlon--epJdemio]ogy, laboratory ~ciences, health edtlcado~, and t raini:lg. CDC Prevention Higbli[tht; Standards for Commun~ly Preventive Health Servlee~*' was daveloped cooper ativeiy over a. two- year period by CDC, the Amerlcan Public Health As,~o¢iation, 1b¢ Association of Stale arad Terri- torial Health Officials, the National A~soclation of County Health Officers, and the U.S, Confer- e~ce of City Heallh Officers. Early in FY 1980, the Secretary of DHHS tran~tnitted the model standards document to the Congress. Five stat~s have used the model slandards for s~ch purr~oses as program planning, ptrformance-ba~ed futtding of local serviee~, and evaluation. CDC has awarded two evaluallon contracts to asse~s both S,ate and local negotiations to agree on quan- titative targets for community objectives and subsequent sueees~ in reaching these targets, Reorgalfizatlotl. In October 1980, DHHS completed a reotganiz~ioD of the eomponent~ of the CDC to fa¢illtafe a more effective response to the heMth problems of the 19g0s. The name of the Center w~s changed to 1he CTenters for Disease Control, and nix operational units were established: the Center for EnvlronmentaI Health, the Center for Health Promotion ~nd Education, the Center for Prevention Services, the National Institut~ for Occupational Safety a~d He~ltb~ t]~¢ Center for Professional Development and Tr~nillg, and the Center for Infectious Diseases, The descriptions for CDC highl~hts are arranged ~ecordi~g to the old organization; however, the challges under the r~org~ization ar~ noted for each ~ection. Model Sttmdards for Commuttity Pr~vetttive lleallh Serviees. By developing r~allstic commu- nily-speci~c ob~ectlvcs, S~ate a~d local health agencies can establish their priorities for eddr~ss- inn critical public health problems. To a~slst these pla~mlng ef~orl~, a document entidad "Model Bureau of Epidemiology The Bureau of Epidemiology maintains surveil- lance over communicable diseases and c~r t ain pre- venlahle coodltlons of national importatlce, a~ develops programs of international surveillance in collaboratit~n with the Office of lnternafit~nal Health, the Agency for lnternatlon~l Deve/op- ment. the Department of Defense, the Dcpar tm~at of ~tate, the World Health Organization, and the Pan Amerlca~ Health Organization. This 8~reau conducts the nadorial quarantine program, inves- tigates special disease problems, participates in the evaluation of experjrrrenta] ~ accine~, provid~ epi- demic aid to States and foreign countries, and re- cruits and trains public health epidemiologists. Urger ~he reorganizallort, (he fotletions of the Bureau of Epidemiology are assumed by the new Epidemlology Program Office and the Centers (or Prevention Service% E~vironmental Health~ arid Infectious Diseases.

Bureau of Epldemlolo~y prevention Hi~hli~hts Sludges of Radi~llo~ Careino~ene~i~ ~nd Nuclear Bomb Testing. The Bureau is asses- ins the eonnectlon between radiation a~d cancer througb a continulng study of military personnel present at the 1957 atmospheric nuclear bomb detonation during test "Smokey" in Nevada. Ini- tial findings of cxces~ leukemia were pnb/ish~ in 1980 (JAMA, Oclober 3, 1980). A study ha.~ been completed, in cooperation with the UlllvCr- sity of Utah, of populations in southern Utah that were exposed to fallout from atmospheric nuclear testing at the Nevada test site. This ~]lout iI~ay have caLfsed increased exposur~ ill dOWH w~nd areas. Study of Hgman Exposure Io DDT. CDC and other agencies are conduetlng a combined epidemiofogic/laboratory/field study of human exposure to DDT residues in Triana, Alabama, associated with consumption of highly ¢on- taminated fish. Serum levels of DDT in a number of lifelong residents were much higher than nor- mal. Subsequent studies documented con- taminatlo~ ~om another very toxic chemical, PCB. Environmental testing showed the river to be highly contaminated. Polio Containment in Amish Communities, In 1979, CDC reacted to the spread of poliomyelitis from the Netherlands through Canada to the United States by stlmuIating con- trol cf~rts. This effort successfully limited the 1979 outbreak of polio in the United States to only 15 cases. All the victims in these cases were mlvaceinated Amish, a~d a vaccination program was initiated in Amish communities in 23 states. In 1980. after the vaccination pro- gram. no additional cases were found. Study u~ Conlraeeplives and Risk of Cancer. Because almost 20 million American women have used oral contraceptives, in 1980 CDC initiated a program in cooperation with NIH to determine whether the hormonal agents in contraceptives influence a user's ri~k of hreasl, endometrlal, or ovarian cancer, The long-term study is designed to document the in- cidence rates of these cancers among groups Of women in re]orlon to use or nonuse of oral con- traceptives. Mierobiologie Guidelines for Homo- dialysis Centers. In 1979, collaborating with NIFI, FDA, and the Health Care Financing Ad- minislration (HCFA), CDC recommended micro- biologi¢ guidelines for bemodialysis centers. The purpose of the guidelines is to eliminate pyrogenie reaedon~--one of the most common complications of dialysis. CDC provides laboratory and epldemioIogie support to the State~ in investigating outbreaks of these reac- tions and is now testing newly developed disinfectants designed specifically for hemodialy- sis ~ystem~. Test for Hepatitis A. From 670,000 to 3,350,000 cases of Hepatitis A occur in the United States annually. Specific diagnosis of Hepatitis A is now possible by a serologic test developed by CDC. using a single blood specimen to measure the presence of a virus speclfJ¢ IgM antibody. In 1980 this test became available as a commercial test used to determine those populations at risk of contracting hepatitis, in eluding infants and children in day care centers, a population that probably accounts for more than one half of the Hepatitis A in certain areas. Hepatlti~ B Vaccine. CDC is evaIuating a prototype Hepatitis B vaccine and has recom- mended measures to control the spread of Hepatitis B in high-risk health care en- vironments, including hemodialysis centers and denial operatorie~, as well as reeommendatfon~ for the sterilization and disillfeedon of patient care equipment such as endoscopes. The vac- cine trial--a joint effort by the FDA Bureau of Epldemiology and State Servicesmwas initiated in FY 1980. The FDA Bureau of Biologics will review the results in determining licensing of the new vaccine. Diabetes Control Project. CDC developed an innovative prevention program to reduce eompScations, hospitalization, and premature death through improved availability of diabetes education care. Diabetics are more than twice as susceptible as nondiabelics to coronary heart disease and stroke, show an almost #O-fold higher amputation rate, are hospitalized 2.5 times more frequently, and have longer average hospital stays. The current diabetic population exceeds 5.5 million persons. CDC personnel. together with State health agencies, are guiding demonstration projects funded in 20 States to reduce the problems associated with diabetes through the use of surveglance, epidemiologic studies, health planning, program evaluation, and resource coordination, Analysis of disease trend data will help each State measure its progress toward a concrete reduction of diabetes~ssoelated illness and d~ath. 45

Bureau of Health Education (BHE) The Bureau of Health Education (BHE) spun- sort a eomprehenslve national program for deployment of health education measures to preven~ dlsease, dlsability, premature death, and ~ndcslrable and unnecessary health problems. Working with and through the regional of flees. the I~HE encourages and assists in the broader al> pheat ion of effective health education programs at the State and communltv levels. The BHE also develops mechanisms for enhancing health educa- tion a~ivitles of the private sector; partieipate~ in, and provides Muff support for, the futradepart- mental Health Education Board; and maintains liaison with other Federal agencies and with public and private organizations engaged in health educat fun activities. Under the reorganization, the Bureau of Health Education is incorporated into the new (-'enter for Heahh Promotion 3nO Educa- tion. BHE prevention Highlights School Health Education Model~. BHE has developed, tested, and distributed nationally two models of heahh education for youth in kindergarten and Grades 1 through 7. These models employ the latest education resources and methods to help schoolchildren under~tand their bodies and appreciate how llfe~tyle, at- titude, and behavior ¢nn either promote good health or contribute to disease. One model, the School Health Curriculum Project (SHCP), was first developed in the early 1970s and is presently used by 5,350 teachers of L;rades 4 to 7, CDC has initiated a three-gear study to com- pare the effeclivertess of SHCP with that of three other school health education programs. 46 Ri~k Reduction Grants. In September 1979 CDC ;nidated a program of grants to help State health agencies conduct health educalion pro- grams aimed at reducing preventable death and dlsability associated with cigarette smoking, obesity* alcohol abuse, hJgb blood pressure, and o~her factors contingent on indivldua] behavior. The States established liaisons with organi?,a- don'; and groups conducting risk rcdueBon ac- tivities and, as an ald to program eva[nation, developed systems to survey the prevalence Of risk factors associated with chronic and preyed- table d{~eases. GranLs were made in 47 states. In 1980 CDC re~eived more than 600 grant ap- plications from State and Ideal agencies and ex- panded the funding of risk reduction programs at the community [oval. The 19g0 program pto- vides that the majority of these funds support pro~eet~ to deter ~moking and alcohol use by youth. The guidelines for this grant program and review of applleations were conducted in cooperation with the Office on Smoking and Health; the Office of Health Information. H~th Promotion and Physical Fitness and Sports Medicine; and the National Institute on Alcohol Abuse ~md Alcoholism. Bureau of Laboratories The Bureau of Laboratories administers a comprehensive national laboratory improvement program. Its responsibilities include conducting both research aimed at improving laboratory methodology and a program to standardize clinical laboratory methods and materials. The Bureau aids in digc~se prevention by providing consultation, training, and information services in laboratory techniques add ltmnagemeni to States and other recipients, and consultation and epidemic aid in the area of vector-borne infect ions to State, Federal. and interrlationzi agencies. Under the reorganization, the Bureau of Laboratorie~ is incorporated into the Laboratory Improvement Progratn Off lee and the Centers for Erlvironmental Health and Inactions Disease. Bureau of Laboratories prevention Highlight~ Legionnaires" Disease. In 1979 use of stan- dard techniques led to the identification of the bacterial cause. Legionella pneumophi/a, or Legionnaires' disease, a type of pneumonia. The Bureau of Laboratories and the Bureau of Epidemiology collaborated in the search, which also led to the recognition of atypical Legionetladige organisms (ALLO), a group of bacteria that cause pneumonia in humans. Research on the antigenic structure of the Legionnaire organism has resulted in the isola- tion and puriflcatiotl of immunizing factors that have successfully protected animals given a lethal dose of the organism. Techttiques for rapid diagnosis have been developed, and evidence is growing that the use of eryt hromyein is an effective treatment of the disease. Botulism Detcctlou. Collaborative efforts of the Bureau of Laboratories and the Bureau of Epidemioit~gy have improved laboratory technology for the detection of botulism to in- crease the accuracy of diagnosis from 33 t~r- cent to g7 percent. Recognition of infant botulism as a cIfaical entity in 1976 was largely a result of perfoetlng the methods for copreex- amination for botulina[ toxin and CIostridtum botulfaum. More Lhan 1(30 eases of infant botulism have been confirmed in the United States, and cases are now being diagnosed in

other countries. The sudden infant death syn drome (SIDS) is an important cause of infant death for which no apparent cause has been detected. Preliminary data from studies con- ducted in Washington and California suggest that about 5 percent of SIDS may be caused by bottdism. A systematic study is under way to determine further the reIatlonshlb between in- ~nl botulism and SIDS in ~he United States. Schistosomiasis Dru~. A safe and effective amischistosomal drug has never been available to ciinlcian~ in the United States and Puerto Rico. Oxamniqnine is a promising agent that may fulfill the requirements of efficacy and minimal toxicity for broad usage. In collaboration with the University of Puerto Rico School of Medicine in 1979. the Bureau of l.ahoratori~ initiated a double blind clinical trial of the efficacy of oral Oxamolquine in the treatment of patients (30 adult males. 17 years of age or older) with chronic Manson's schistosomiasis. In 22 patients treated SO BIt, Scgistosomo manso~i egg counts were reduced by more than 95 percent, one month after treatment. After three months, all patients receiv- ing Oxamniquine had ceased to excrete ~ mansoni eggs. Side effects have been minimal and welI tolerated in all instances. On the basis of these results, it is expected that an available, safe. and effective medicament will be approved for treat- ment of individuals in this count ry infected with S. 1~TGr~soni. Bureau of Smallpox Eradication (BSE) The Bureau of Smallpox Eradication (BSE) has in the past directed and coordinated the surveillance of smallpox and smallpox vacclna- lions within the United States, as well as directed, coordinated, and managed United States participation in the worldwide program for eradication of smallpox. With the eradication of smallpox, the Bureau now principally designs public health programs based on techniques and methodologies developed in smallpox eradica- tion acdvitles. Its Research and Development Division develops field tests and makes recom- mendations on the adoption of new and improved procedures to assist developing countries in improving their public heahh programs. In addi- tion, the Division plans, conducts, and evaluates research activities in various aspects of disease ¢ontroI for immunization programs. Under the reorganization, the functions of the Bureau of Smallpox Eradication are assumed by the International Health Program Office and the Center for Health Promotion and Education. BSE Prevention Highlights Eradication of Smallpox. The World Health Organization (WHO) certified the eradication of smallpox in the Horn of Africa (Somalia and southeastern Ethiopia) in October 1979, mark ing the first two-year period in recorded history during which there was no endemic transmis- sion of the disease in that region. CDC provided tong- and short-term epidemiologie consultants to WHO's worldwide campaign to eradicate smallpox. Staff members participated in the for- maI WHO certification process in 1979 by serv- ing on teams visiting the Horn of Africa to ensure continuing absence of the disease, This program is described in greater detail in Chap- ter 1. Detection of Iron Deficiency. BSE is assess ing the laboratory criteria to document, within defined ecot~omic and social groupings, the thera- peutic response to iron deficiency in one-year- old infants. This study is expected to identify the most cost-effectlve methods of screening in- fants for iron deficiency and to improve the pIan- ning and administration of food supplementation programs. The results of this investigation will also expand present knowledge supporting clinical nutritional approaches to reducing infant health risks and enhancing CDC's capability to provide technical assistance in this area. Bureau of State Services The Bureau of State Services has been responsible for planning, directing, and coor- dinating a national program for assistance to State and local health agencies in the preven- tion, control, and eventual eradication of serious infectious diseases--such as gonorrhea, measles, poliomyelitis, rubella, syphilis, and tuber- cu[osis--fur which specific preventive measures are available. B also administers programs for the control of environmentally induced human health problems, conducts research relative to health problems within its concern, and provides assistance in analyzing the influence of various factors such as socio-economic status, nutritional status, and demographic characteristics on the in- cidence and severity of preventable diseases. Under the reorganization, the programs of the Bureau of State Services are transferred to the Centers for Prevention Services and Environment- aI Health. 47

Bureau of State Ser~'ic(:s P~'ventiotz Hi~hfishts STD Trainin~ Clinics. Wdh Ih¢ e×pandlng knowledge abo~I sexually transmitted disease~ iSTD) and the documented need 1o improve general clinical eomp~:t~ncc among Drivate and p~Jblie health care providers. CE)C seeks to im prove clinical care sk0is among health practi tioners and providers of health ca~e services. One appr oac~ ~o ~cbievi~ Ibis aim h~ e~ployed production of publicatlons and sponsorship of medical symposia. To emphasize prevention. CDC has cosponsored a razor inter nadonal Sym- ~@siLzm on Pelvic Inflammatory Di~ease, one of the" ~os{ Cotnmon complications of gonorrhea. CDC has also established six regionM STD Train- ing/Prevcntion Clinics. Housed within public health facilities il~ Chicago. Cincinnati. Dallas, Denver. LO~ Angeles. and Scattte. these clinics u dlize the teaching intents of p~ hiic healf h practi- tioners and medical school faculty members to provide experlment~l training in the muhiple disciplines involved in STD clinical care, ~uorld~(~u Inifisfi~e. Because ~uor~afiorz of water ~upplies is an important means of decreasing tooth decaY, in 1979 CDC eslabllshed a fluoridation pro~ect grant program to provide financial and technical assistance to States and communities, These grantees have initiated the fluoridation of approximately 45 water %v~lem servi~ an estimated 400,000 People in small comrannilies with populations onder 25.0(30. The water ~upgIied to 60 rural schools servlng approx~mateiy 20.(g~0 stu~J~nts was also I~uor~datcd. The program was expanded in 19~0. and by lhe end of 1980. a~ eslimated 4,26 m01ion addifonal people were receiving the benefits of fluoridation. CDC has provided 4~ technical assistance to grant appllcants and other communities ~reparing for hearings. referenda, or litigatior~ about ~uoridatiom Childhood Immunizations. In 1977 the President initiated a n~tdonwide campaign to ~n- crease childhood immuniz~adon levels and to establish a follow-up system to enst.tre that im- mut~izati~n series for oe~horn~ hc Completed al the a[?propriate age. All States now require im- munizations as a eondltlon of school entry, By October [979. the immunization g~ml for school- children was reached~ 91 percent of school- children in kindergarten {hrough eighth grade wcrc immunized against measles, polio, diph- [herL~. te~nu$, and pe~lvssJs. As a r~ult, the incidence of childhood disease~ preventable by immunization has declined dramatically. The number of reported cases of measles, rubella. and mumps was substantialty lower for the first 4"~ weeks of I980 than for Ihe same period of 1977--a "}6 percent decline for measles, 82 per- cent for rubella, and 58 percent for mumps. A goal was established in 1980 to eliminate in- digenous measles in the United States by Oc- tober 1, 1982. Influenza Immunization, The people most at risk for influenza complications, including death, are the chronically ill and the elderly. To immnnlze these populations, CDC awarded grants for FY 1979 to 42 states, the District of Columbia, 2 territories, and 6 local areas. In all. 3.9 million doses of influenza vaccine were made available for these immunization projects from !97g through !9~ CDC continued to provide teehnleai ass~slance to more than 60 grantees in pbelnJng influenza i/l~rnlmJzatJoD programs, Bureau of Training The Bureau of Training is the primary source of expertise in the Beld of instrucdonal/oerfor- mance technology within CDC, The Bureau assists disease prevention and control programs at the local State, national, and international levels to reduce unnecessary morbidity and mor- tai0y Ihat may result from the failure to apply existing sclentifie, technical, or operational khowledgc. Specifically, the Bureau conducts a program to update and improve the performance of practicing health professionals in the methods and techniques of disease prevention and control; promotes the establishment, maintenance, and improvement of State and other health training programs; provides disease control training and consultation on natural disasters and epidemics; develops and advises on advanced training technology and method- ologies through the above activitle~; and co~r- dlnates the Center's training actkilies. In 1979 at~d 1980. technical assistance, consultation, and inMructional resource materiats were provided to more than 509 organizations. Under the reorganization, the Bureau of Training becomes the Center for Professional Development and Training. Bureau of Training Prevention Highliihls Training for Immulclz~lion Program Man~ger~, The director of the World Health Organization's Global Programme has emphasized training and planning for immunization efforts. At his request, CDC has developed a senior-level course for na- tional program managers that has be~n ~t{ler~ded by more than 400 managers of developing coutl Iries with inlmunization program~, and has

designed told-level management training for managers of imr~tullza~ion programs ~brou~bout the '~orld. CDC has made planning assistance available worldwide and at reglonal and national levels. Bureau of Tropical Diseases (BTD) The Bureau of Tropical Diseases (BTD) directs a program of research and investigation of vector borne and eropical diseases, such as Chagas' disease, onchocerciasls, shlgella. malaria, and other parasitic diseases. The BTD develops and evaluates methods, including insec- ticidal and biological control measures, of the fu- sector vectors and the diseases they transmit; it conducts investigations on the bionomies of insect vectors, and researches the host parasite relation- ship of such diseases. Through interrelated laboratories in the United States and the tropics, BTD provides assistance to other scientific, educe tlonal, and health organiz~atlons in developing competencies in the epidemiology and control of tropicaI and vectorborne diseases. In addition, the Bureau collaborates with, and provides technical consultation to. other United States government agencies and international organizations in the development, evaluation, and appIication of con- trol measures. Under the reorganization, the pro- grams of the Bureau of Tropical Diseases become part of the Center for Infectious Diseases. National Institute for Occupational Safety and Health (NIOSH) The goal of NIOSI{ is to assure safe and healthful working conditions for every working man and woman in the United States. TO that end. NIOSH plans, directs, coordinates the na- bonal program to develop and establish oecupa tional safety and health standards and to con- duct research, training, technical assistance. and related activities. The Institute seeks to develop innovative methods and approaches to deal with occupational safety and health prob lems. and to provide medical criteria to ensure the protection of employee~ from diminished health, functional capacity, or life expectancy because of work experience. NIOSH consults with other Federal agencies. State and local government agencies, and industry and employee organizations to effect progress in pc cupational safety and health. NIOSH P~evention Highlights Criteria Documents and Health Hazard Evaluations. One of the most important preven- tion efforts b~.," NIOSH is the development of criteria documents that, for a given hazard, recommend environmental exposure limits, medical examination requirements, labeling and warning, environmental monitoring methods, engineering controls, workplace practices, per sonal protective equipment and clothing, and record-keeoing requirements. Criteria docu- ments have an effect on the workpIace even before being promulgated as standards. Labor and industry use them as guides for control of hazards even though the documents do not have the force of law. In FY 1980. 12 criteria docu- ments were completed, and others were initi ated. NIOSH also began producing health hazard evaluations, which are briefer than crltctla dwtnnents and are designed primarily to review the state of knowledge about the health effects of a partieuIar substance, process, or in- dustry. NIOSH eompleted 132 health hazard evafu~tions in FY 1979, and I67 in FY 1980. FMucational Resource Centers (ERCs). The N]OS|I training grant program now includes 33 training project grants and I2 Educational Resource Centers (ERCs), which are strategically located to serve each region of the country. In 1980. the program provided aeedemle educa- tion for approximately 2,000 degree candidates in the fields of industrial hygiene, occupational safety, occupational health nursing, occupa- tional medlcinc, and other related disciplines (toxicology. epldemlology, ergonomics, and biostatistics). 49

Food and Drug Administration (FDA) 5~ FDA is the regulatory agency responsible for assuring that all foods, drugs, cosmetics, and medical devices used or consumed by ~he pubI/c are safe. sanitary, properly labeled, and effcctive. FDA tests new drugs, food additives, and certain medieal devices before they are marketed, and conducts in~pcctlons of relaled manufacturing and processing plants, The agency issues public warnings when haz2,r dous products are identified. and it is empowered to remove unsafe products from the market. FDA is authorized to initiate legal actlon in the event of misleading labeling. FDA's program activities are distributed among six bureaus--the Bureau of Drugs. Bureau of Foods. Bureau of Biologics. Bureau of Radlologie Health. Bureau of Veterinary Medicine. and Bureau of Medical Devices--as well as the Na- tional Cerlter for Toxicological Research. FDA Prevention Highlights Nutrition Education Materlab. TO promote good health through knowledge of nutrition, FDA contracted in 1978 with the University of North Carolina to develop a model course in applied nutrition for health l~rofessional students who would participate both in classroom instruction and in clinical care of community patients. Thhty- flv¢ of the 45 el~sroom sessions were designed as self instructional programs, and a curriculum guide was developed for facuhy members and for other health professionals who might wish to con- duct a similar course. Now in its third year, this program aims to evaluate the existing test com- ponents of the course in order ~o expanti them for devcio!ament of a manual of test materia[~ to be used natlona[ly and intcrehangeably with the se!f- instructional program. Bureau of Biologics The regulation of biological products is the re- sponsibility of FDA's Bureau of Biologics. Regu- lated products include polio anti measles vaccines. diphtheria and tetanu~ toxoids, shin test sub- stances, and whole blood for transfusions. Since most biological products are derived from living organisms, they are by their nature lx>tentially dangerous if improperly prepared or tested. Therefore, the Bureau of Biologics tests many of these products before their release by the manu- facturer for general use. Because biologics are legally defined as "drugs," the Bureau ensures that all biological products meet the requirements for safety and effectiveness prescribed by the Pub- lie Health Service Act and appropriate sections of the Food, Drug, and Cosmetic Act. Bureau of Drags Medicines are an FDA responsibility assigned to the Bureau of Drugs. The Bureau must approve a/l new tirtlgs for safety and effectiveness before they can be sold to the public. Approval is based on ~x- tensive scientl fie data and test results submitted to the Bureau by the organization seeking authoriza- tion to market the drug (normally the drug's man- ofaelure0. The manufacturer must demonstrate its abillty to manufacture high-quality product~. The Bureau is aLso concerned with proper drug labeling and requires that Iabds contain adequate warnings and directions for use. Bureau of Dmg¢ Prevention Highlights Patient Package Inserts. FDA proposed a re- quirement that mo~t prescription drugs have package inserts to inform consumers about the ap- propriate uses of the drug. possible side effects, and

proper procedures for administering the drug. By means of this rcQuirement, the Bureau aims to en- siJre the szffe and effective nse of drugs and to en- courage ~tierlts to participate more actively in their personal health care problems. Effective Oc- tober 14. 1980. final regulations require package in- serts, wrilten in nontechnical language, to be pre- pared and distributed by the manufacturer. The Bureatl intends to make these regulations effective For 10 drugs or drug classes during an initial three- Year l)eriod. Prescription Drugs: National Consumer Educa- tion Carapaign. FDA has initiated a comprehcnslve campaign to educate consumers about the safe alld effective use of prescription drugs. A major theme of the campaign is the hazards inherent in an "ovcrmcdlcated society." Inefaded are Iclevislon and radio public service announcements, in English and Spanish. FDA has secured the aid of health professionals to encourage dialogue between physi- cians and patients and hetwecn consumers and pharmaclsts. The campaign is being coordinated with activhics of the National Institute on Drug Abuse. ~lal Alcohol Syndrome: National Consumer Education Campaign. Babies born to mothers who drink excesslvely during pregnancy suffer physical and mental defects inciadlug slow growth before and of let birth, head and facial irregularities, defec- tive organs, malformed limbs, mental retardation, and other abnormalities. In cooperation with the National Institute on Alcohol Abuse and Alcohol- ism and the P.nrcan of Alcohol. Tobacco, and Firearms, the FDA has cooperated in a program initiated in May 1978 to alert the public, especially pregnant women, to the potential heahh haT~ards that alcohol poses for unborn children. Among the elements of this continuing campaign are publlc service announcements that have been delivered to radio al~d television stations across the country and relevant articles published in FDA journals and dist ribnted nat fanwide. Darvon: Nntion2l Educational Effort, In Tesponse to r~nt discoveries of eeTtaln risks asso- ciated wilh the use of the drug Darvon (propoxy pheneL FDA issued a special Drag Bulletin in 1979 to alert physicians, pharmacists, dentists, and other health professionals about these risks. An article on foe subjecl was printed in FDA Consumer, avail- able to the public through the Consumer Informa- tion Center. FDA ordered a major new boxed warning about Darvon in 1979 to discourage un- necessary use and to promote care in prescribing the drug. In 1980 FDA requested that physicians write "no refilr' on prescriptions and that they !ore scribe the drug only in writing. Recent information indicates an increase in physician and patient awareness of the potential for abuse of propoxy- phene and a concurrent reduction in the number of prescriptions and in deaths and emergency room visits occasioned by abuse of the drug. Poison Control program. FDA directs a national program of activities related to accidental poison- ings. As a part of this effort, FDA assists local pre- vention and treatment activities in such ways as providing educational materials and scientific data on the toxicity of drugs and other chemicals. Each year FDA participates in National Poison Control Week. an effort to focus public attention on this important public health problem. Bureau of Foods The Bureau of Foods conducts research, main- tains data, and develops regulations and standards on the composition, quality, nutrition, safety, and purity of foods, food additives, colors, and cos- metics. The Bureau also has the responsibility of checking labeling and packaging for aecuraeg. Effective food labeling can contribute to the Na- tion's health by helping consumers choose foods with the al3propriale caloric and nutrlem values. Because advances in tech no~ogy have created more processed and fabricated foods, and because the rcladonship of nutrition to certain diseases is becoming better understood, acenrate and infor- mative labeling about a produces nutrient content and its other eharaeteelstles has even greater pub- lie health significance now than in the past. Fur- thermore, disease and other abnormal psyehologi- col conditions such &s allergies compel many Americans to follow special diets. These people especially need informative food labeling. FDA is working with lbe food induslry to promote volun- tary listing of nutrition information on labels. Bureau of Foods Preventlon Highlights Food Labeling Revisions. The FDA, the United States Department of Agriculture (USDA), and the Federal Trade Commission (FFC) announced in the l~hderal Register on December 21, 1979, their tentative positions on a variety of food label iug issues. The positions were the result of the agencies' analyses and evaluations of written and oral commenls received in response to a notice published in the Federal Register on June 9, 1978, requesting the public's views on several food label ing issues. The FDA, USDA, and FTC held public hearings across the country between August and Pert)bet 1978 to elicil public comments on im proving food labeling, after which they accepted written submissions. These positions also reflect the results of FDA's Consumer Food Labeling Survey, conducted in the autumn of 197g, 1o gather consumer's views on food labeling. 51

Yood Additives: National Consumer Edtleation Campalglt. To provide the consumer with a better understandlng of food additives, the FDA created a slide presentation and ]~ ublished a ~eries of dfas- trated artlcles in the FDA Consumer listing the different kinds of food eddltive, their uses. and how to identify them on food labels, including a discussion of their histories and legal status. These materials have been reprinted and distributed na- tionally through FDA's Consumer Affairs Office and the Consumer Information Center. Sacchatln and Cancer Study. In 1979 FDA arid the National Cancer institute released the prelimi- nary findings of an epidemiotogic study that ex- amiaod the relationship between the use of the artificial sweeteners gaccharin and cyclamate and the incidence of bladder cancer in humans. The study was pronlpted by the findings that saccharin was a weak carcinogen in laboratory animals. Pre- fiminary results, involving almost 9,0CO people in five states and five metropolitan areas, indicated no increased risk of bladder cancer among users of artificial sweeteners in the overall study popula tion, However, there was some evidence that arti- ficial sweetener consumption may he hazardous to heavy users (six or more ~trvlngs a day of a sugar substitute or two or more 8 ounce diet beverages a day) of artificial sweeteners. Infant Formula Quality Control procedures. The identification of health hazards associated with chlorlde deficient, soy-based infant formulas oromoted FDA in 1979 to review quality control procedures to assure that deficiencies or other haz~ardous conditions will not occur in the future. In that year one manufacturer produced infant for- mulas having insufficient chloride. The feeding of this inadequate formula resulted in t~ substantial number of cases of hypoehloremie metabolic alka- losis in infants. Congress has recently passed, and the President has signed, an amendment to the Food, Drug. and Cosmetic Act stipulatlng, among other things, than an infant formula be called adul- terated if ~t does not meet the quality factor require~ ments established by the S¢'eretary of DHHS. Nit r re.amines in Akoholie Bt, vtrngeg. The United State~ Brewers AssOCiation (USBA) informed the FDA in 1978 that German researchers had repor ted finding low levels of dimethyfaitrosamine (DMNA) in beer. The FDA arid USBA each surveyed beers and other malt beverages avai~hle in /he United States and reported similar findings. Based on in- formation from the Germans and subsequent inves- tigations by the USBA, it is apparent that DMNA formatiofl occurs principally during the kilning (drying) of sprouted barley used in the production of harley malt. Although other techniques are under experimentation, the USBA has reported that sulfur is being used during kilning for most barley malt currently produced in the United States; as a result, levels of DMNA are substan- tially lowered. Consequently, the level of DMNA in beverages produced from those malts should also be s~bstantiaBy reduced. Warehouse Sanitatlon Industry Education Pro- gram. The Atlanta regional office piloted an in- dustry education program on warehouse sanita- Ifon in FY 1980. Seven workshopg were held for the food warehousing industry to explain to the in- dustry Federal requirements for safe storage of dood products. Other workshops are pfanned for FY [9gl in the Boston. ~a~ford. New York, and Newark districts. A slide show has been repro- duced in English and Spanish and distributed to all the FDA district offices. Bureau of Medical Devices The Bureau of Medical Devices develops policy. promulgates standards, and evaluates the safety, efficacy, and labeling of medical devices. The Bureau conducts research and testing related to medical devices and collects and evaluates data about significant hazards to the public health that may be caused by the use of these instruments. The goal of the Bureau is to educate consumers to participate effectively in their own health care and protect themselves from ineffective, unsafe, or deceptive products. Bureau of Medical Ikviees Prevention Highligh~ Inlrauterine Devices (IUDs). Approximately 15 million women throughout the world and up to 6 million women in the United States use IUDs. These devices can cause in those who use them side cffc~ts and adverse reactions including anemia, blood poisoning, embedment, perforation of the uterus, and septic abortion. A review of IUD labeling in 1974 revealed that thi~ information was not being uniformly supplied to physicians or women patients. As a result, the Intrauterine Con- Ir accptive Devices Professional and Patient Label~ ing final rule was published in May 1977. In FY 1980 fundg were used in an FDA consumer eduea~ lion program about IUDs to provide exhibits, con- sumer articles, consumer memos, and raguIation reference~ to the public. BuPCaU Of P.adio!og[c~ Health The Bureau of Radiologlcal Health is responsi- ble for the protection of the public against the haz~.r ds of radiation. It eondueta research into the

health effects of radiation exposure and estab- lishes standards and controls for safe radiation limits. Bureau of Radiolo~ieal HeaRh--Prevention Highlights Disgnostk X-Rays: Consumer Education. Reducing palient exposure to radiation from X-rays is the goal of a national campaign initiated by the FDA in March 1980. The program empha- sizes education and motivation of the public to re- duce the risks of diagnostic radiation. Radio public service announcements and cooperative programs with professional and consumer organi- zations, hospitals, and secondary schools are cur- rently bringing consumers the following messages: Keep records of X-ray examinations; inform medical personnel about possible pregnancy; in- quire about gonad shielding; and do not insist on having X-ray examinations. It is anticipated that the initiative will encourage State agencies, profes sional organizations, and health facilities to begin or expand their own education programs. criteria for X-Ray Examinations. A major cause of unnecessary X-ray examinations is a lack of scientific data to guide clinicians in deciding when X ray procedures are diagnostically war- ranted. To provide this guidance, FDA is develop- ing recommendations for X-raysmwhen they are and when they are not needed. The clinician can refer to these guldelines and make a decision based on the patient's cIinieal history. The National Conference on Referral Criteria for X-Ray Exami- nations, held in October 1978. produced a recom- mendation about X ray peivbnetry during preg- nancy L~tetement on Use of the X Ray Pelvimetry Examination, published in July 1980). Another group developed a draft statement on adminis- tratively required chest X rays. FDA also sponsors comparable results have been achieved in the clinical research to develop data about the BreastExposureNationwldeTrends(BENT) prc~ usefulness of certain X-ray examinations. The gram. initiated in 1976. agency now supports five grants at universities and teaching hospitals to achieve this goal.Sunlamp and Tanning Bnoth Safety. An esfi mated g00.000 to I million sunlamps are sold in Recommendation Jbout X-Rays of Pregnant this country each year. Overexposure to these Women. The deveIoplng embryo and fetus are lamps can cause immediate harmful effects, such highly sensitive to radiation damage, especially as skin and eye burns, and long-term effects, such during early gestation, when the pregnancy is not as increased risk of skin cancer and accelerated obvious. As a preventive measure. EDA has pro- aging of the skin. To prevent this damage to posed a recommendation advising physicians of health. FDA issued a performance standard for the importance of ascertaining whether a woman sunIamps and suntanning booths, effective May is pregnant before X raying her lower back or ab 1980. requiring timing devices, protective goggles, domen. Physicians will be advised to consult with protection against short-wavelength ultraviolet the radiologist about available options: canceling radiation, warning labels, and instructions for the examination, limiting the examination, re- use. To protect consumers from possible harmful questing the full examination if warranted, or results of using commercial tanning booths, a spe- deferring the examination. When an X-ray exam- eial effort directed both to manufacturers and to ination is being considered, women who may be consumers was initiated in 1980. pregnant are advised to inform medical personnel of this possibility. Laser Light Show Safety. The increasing use of laser devices in indoor and outdoor displays and henri and Mammogmphy Quality A~uranee rock concerts exposes audiences to two types of Prog~ms. Two innovative FDA-designed pro- hazard: impaired vision and dangerous radiation grams now in operation in most states are in- levels. The FDA and Stale and local authorities tended to reduce unnecessary patient exposure are acting to prevent the operation of laser light from dental and breast X-rays. State and local shows that could expose audiences to hazardous radiation control agencies mall special cards con levels of radiation. FDA is informing light show raining miniature radiation measurement devices operators of their responsibilities with respeCl to to facilities that perform dentaI radiography or safety, and is educating sponsors of laser light mammography. The cards areexposed as a patient shows to employ only those whose laser pro- would be, and are returned to the agency, where cedures have been approved by the FDA. they are "read" to determine radiation exposure. Those facilities with inappropriate exposure levels Bureau of Veterinary Medicine are scheduled for consultative visits, during which corrective measures are suggested. The Dental Ex- posure Normalization Technique (DENT) pro- gram, begun in 1972, has demonstrated a 40 per- cent reduction in average patient exposure, and the Bureau of Veterinary Medicine develops, conducts, and evaluates programs to ensure the safety and effectiveness of preparations and devices pro!~osed for use in animals. The Bureau 53

evaluates FDA's ~urvedlanc¢ progralns relating to veterinary drug~ and olher vetcrlnary medical nlatter~. Eighly percent or the ~eat-proguchag animals in the United States are rai~ed on medi- caled feeds, FDA's Bureau of Veterinary Medi elnc is rcsponslble ~o~ ensuring thai fecd~ are sa~e and effective, lhat farmers understand how to use them. and that food'g from animals are free from drug cont anlination. National Center for Toxicological Research (NCTR) The Naliona] Center for Toxicological Research is a~t FDA/EPA faellky that conducts a research program to improve the power of science to pre- dict the toxic effecB of chemicals and thereby pre- venl ~beir adverse effects OB humans, Th~ chemi- cals may appear in the air. in water, in foods, or in drugs, Under this program more tellable lesls are developed for predicting genetic damage, neuro toxieky, earcinogc~icit)', reproductive add fetal toxleltv, immunotoxichv, and cellular toxicity. NCTR aims to develop improved methods of extrapolating toxiclty data from anivoals 1o humans so thief th~t regtdatory agencies can bqtter as~e~¢~: horrtan rh;k. The Cenler perforras compre- hensive toxicological evaluations for selected chemicals of par tlcular interest to FDA, EPA, and the National Toxleology Program. Health Resources Administration (HRA) 54 The several missions of the Health Resources AdroinJstratJoo ineJode: to ide~ti~v health care resource need~ through a careful ~Lssessment of the health care sy,qtem; to recommend changes to im- prove access to health care, improve ¢ontinulty of health care, assure equal access to health educe lion, and e~h~nce lhe Federal State, l~], and private par tnershlp~ and) through pr ogratn action, to itaprov¢ both the heatlh care system and invidi dual health status. HRA focuses on pr~ventlon arid health promotion igsue~ in a number of spe- cific areas, inciudlng preparation and trai~ing of health profussionalsi preventive services in regional heaRh planning arid resource develop mentl and disease prevention and health promo- tion actlvities and health status onteordes, as de- nned by the Natloaal Health Planning Goals. Bureau of Health Planning (BHP) The Bureau of Health Planning, through a net- work uf 20.5 local hea!th #a~ing ~geneies known as Ilealth Systems Agencies (HSAs) and 57 State Health PIannlng and Developmetlt Agencies, is re- sponslhle for regional heahh planning and resource development. These local and State agen cic~ develop and implement ~ans for the provi- SiOn Of services, manpower, and facilities to meet identified needs, and identify and help to reduce inefficient or redundant health care services. Over 95 percent of the HSAs address preventive health services in their plans. Their goals cover a variety of areas including health promotion and educa- tion activities, occupalional and environmental programs, and errors aimed al identifying and corr¢ctiog preventable diseases and conditions. BHP Prevention Highlights Health Promotion Activities. Working through the 8eaith Systems Agencies. BFIP has promoted both general eommualty health and occupational safety and health awareness through a variety of programs. Following are some example~ of ac- tivifieq by HSAs: • A new health support center recently opened in South Bend, Indiana, as a result of an HSA- sponsored conference on health support and a $195,~n00 Bl~e Cross grant. • The Eastern Washington HSA stimulated the development of an innovative program that provides personalized health education services through Wage WaPa Community College, The

new health education center opened in October 1978 in response to a Health Systems Plan priority goal to teach cnn~umers In take respon- sibiTity for their own health care. • Working wlth Motorola Corporation and Gen oral Electfie, the Phoenlx. Arizona, HSA helped ~he~e companies to identify high-risk jobs in their pIants and designed special health education programs for employees in these jobs. • The HSA in Milwaukee. Wisconsin. identified an acute need in that highly industrialized area for nurses trained in occupational safely and health skills, and worked with the University of Wisconsin to design a training program in occu- pational safety and health now offered by the University. • The Madison, Wisconsin, HSA has sponsored annual health promotion workshops for em- ployers and labor; helped businesses and indus tries initiate health promotion projects; sfimu luted the development of resources to assist the projects; and published a guide to developing health promotion programs. As a result of these activities, three large hospitals and two county governments initiated programs for their employees. Disease Prevention Aetiviti~. liSAs are work- ing to increase immunization levels and to carry out a variety of other disease prevention efforts, including the following examples: • Through a major initiative by the Maumee, Ohio, lISA to increase immunization levels for children, every county in the region reached at least a 95 percent compliance with child immu- nization standards. • For the second eonsecutlve year, the Central Indiana HSA joined Blue Cross and Blue Shield in sponsoring the Central Indiana lieahh Fair. Iteld in downtown indianapolis, the fair drew over 35,000 participants. There were nearly leo exhibitors distributing information and provid- ing free health tests for diabetes, cancer, sickle cell anemia, high blood pressure, vision, and hearing. • In Michigan, the Grand Rapids liSA took the Iead in its community to initiate a dental disease prevention program directed at children. Join- ing with the local denial society, the lISA spon- sored a school dental health education program for kindergarten through the sixth grade. Area dentists estimate that to date the program has saved $250,000 in dental treatment costs among these children. Bureau of Health Professionals (BHPr) The Bureau of Health Professions provides na- tional leadership in coordinating, evaluating, and supporting the development and utillzatinn of United States health personnel. It assesses the sup- ply and requirements of the Nation's health pro- fessions and develops and administers programs to meet those requirements; collects and analyzes data and disseminates information on the charac- teristics and capacities of health professions pro ductinn systems; and develops, tests, and demon- strates new and improved approaches to the devel- opment and utilization of health personnel within various patterns of health care delivery and financing systems. The Bureau provides financial support to institutions and individuals for heaIth education programs, administers FederaI pro grams for targeted health personnel development and ufibzatlon, and provides technical assistance in NatlonaI. g~ate, and local agencies, organiza- tions, and ~n~tltutinns for the development, pro ductlon, ntlgzafion, and evaluation of health per sonnvl. The Bureau earrle~ ou~ a variety of pro- gram aefivities to ensure adequate and appro- priately trained health personnel that will con irlhtlte to the development of disea';e prevention and health promolinn services. BHPr Prevention Hi~hlight~ Curriculum Models in Occupational, Industrial, and Environmental Medicine. Most medical school curricula are deficient in the areas of nccu patinnal, industrial and environmental medicine. BliPr has contracted for FY 1979 and FY 1980 with the University of Arizona Center of Occupa- tional Safety and Heahb to implement and evalu ate cur rieulum models to correct this deficiency in five medical schools. The immediate and long- term effects of the models on the students will be measured, and the curricula will be disseminated to other teaching institutions. Contract modifica- tions in FY 19g I will supporl the development of a Iearning module on alcohoI and drug abuse as a part of an interagency agreement with the Na- tional Institute on Alcoholism and Alcohol Abuse. A national conference will facilitate dissemination of lhe materials being developed. School Nurse Practitioner Grant. The Univer- sity of Colorado School of Nursing, through a grant renewed in I980 to prepare school nurse practitioners, has developed a series of teaehlng aids for the education of eh~!dre*L Thes~- ~ncinde comic books for young children and the develop- ment of a personal heahh history that emphasizes participatory health consumer roles in nutrition, immunizations, and exercise. 55

Nutrition Curriculum Development, ThirtY'on grants for $1.5 million were awarded in FY 1979 and continued in the following year to profession- als in nutritional assessment and counseling. All the grants Include medical students or residents as well as other health professionals in training and have as their purpose the development or expan- sion of courses to improve student gkdls in using nntrilion concepts integral to their patient care ac tivities. SevcraL interdisciplinary training courses. clinical and didactic in format, were devetoped during the firm year. Some of the pro~e¢ts have developed self-instructional modules on specific topics in nutrition. Computer-assigned instruction modules, videotapes, patient education materials, and computerized clinical assessment materials have also been developed. Environmental Health Curriculum I)evtlop- mellt. Protecting consumers from exposure to harm Inl envir onmet~tal factors is the aldmate goal of ]5 curriculum development grants totaling nearly $1 million. Instructional materials are being developed to educate medical students about en- vironmental diseases--theE cause, diagnosis, trealment, prevention, and identification of potential exposures, Curriculum Models in Preventive Dentistry. Five dental schools were awarded contracts to develop and implement curricula tO train dental students to plan. organigJe, and arrange the deliv- ery of community preventive services. A total of 804 students were trained, and a full range of com- munities and target populations were provided with preventive dentistry services. It is anticipated that this program will etlhance the awareness of future dentistry practitioners of the need for pre- ventive dentistry in their communities. Tfaineeshlp Grants and Special Proje¢ls, Both Public Health Service Traineeship Grants and the Special Projects Program reflect the effort to ex partd disease prevention and health promotion eurrleulum hdtlatives to inclttde epidemiology, en- vironmental and oceupatlnnal health, and die- reties or Iqutrition. Though precise measures of the shortages of Duhlic heallh personnel are no1 avail- able because methodological difficulties, the 1979 report on public and community health personnel, prepared at the request of Congress. estimates that 150.0CO peoOle are wholly engaged in public health work, Existing studies and prevailing expert judgment indicate chronic shortages of certain types of specialist, including epidemioinglsts and biostatlsticians. In FY 1979 there were 75 special project grant awards, and 64 the following year. to expand or develop programs in tbes¢ areas. Twenty-one new traineeship grants and 14 con- tinuation grants were made in FY 1979 to ac- credited schools of publi¢ health and other educa- tion institutions: in FY 1980, 27 new traineeship grants and one continuation grant were awarded. Health Services Administration (HSA) The programs administered by the Health Serv ices Administration are designed to provide com- prehensive p~rnafy health care servlc.~es. /aISA ac- complishes this goal by encouraging health profes- sionals 1o estahlish their pract~es in medically nnderserved ~ommunitics, by ¢orrecling inade quao~ in Ibe natioaal d~s~rihution of hea/th serv- ices, by improving the quality of health care whiIe fosterlug more ¢ffleient methods of dcliverlng it, and by directly providing hospital and clinical care ~o cer~ir~ !egn!!y defined grouo~ of citizens. HSA's community programs bring health care to prtviously neglected areas by identifying local health care n~eds and by opening neighborhood and family he~tlth centers that involve the residents irt actual work at the centers. Comprchetlslve primary health care centers now serve the needs of d.J million people, and the Indian Health Service provldes health car~ to 700~000 Pdrnerican Indians and Alaskan ,Natives. 56

Bureau of Community Health Services (BCHS) The primary goal of the Bureau of Community Health Services is to assure the availability and delivery of hlgh-qualitv health scrvlces to American Communities. Special attention is directed to the establishment and organization of primary health care services in areas where they are nonexlstant or insufficient. SI~cial programs are conducted for migrant workers, mothers and children, chlidren with crippling conditions, families unable to afford necessary comprehensive family planning services, victims of black lung disease, persons with hypertension, and Ap- palachian residents. The BCHS National Health Servlc¢ Corps recruits health care pro ~ssionals to serve in areas that have shortages of such profes- sionals. Corps I~rsonllei not only improve services in the communities, but also help each area to develop its OWn continuing system of health care. BCHS Prevention Highlights Productivily/Effectiveness Initiative. During Fiscal Year 1979, the BCHS developed an faitia dve to increase productivity and effectiveness in ambulatory care projects. The aim of this pro)act is to measure effective and efficient performance against published criteria as a condition for awarding confnuatlon grants and providing tech- nical assistance. Some of the specific indicators re- lated to prevention include immunizations, pre natal care, family planning counse!fa~ for adoles cents, Pop smear follow up, hypertension sereen~ ing, and anemia screening. Accident Prevention and Injury Control in Children. To decrease prevenlable disabliity and death from injuries and/or accidents, BCHS and the Bureau of Medical Services are developing Preventive and Emergency Child Health Care Sys- tems. Three demonstration projects carried out under the auspices of State maternal and child health programs in different parts of the country are improving the collection and analysis of demo- graphic, epidemiologlc, and operational systems data related to accidents involviag children. The data are used to identify those children who are most likely to suffer accidents and to deveIop spe- cific approaches to controlling injuries to such children. The projects involve the coordinated ef- forts of a broad spectrum of State and locaI public agencies, neighborhood ~nd voluntary organiza- tions, professional associations, and the private sector. Family Planning Information. The National Clearinghouse for Family Phmnfag Information began its fifth year of operation in August 1980. This service provides information to consumers and potential consumers about the benefits of family planning servlccs. The Clearinghouse has distributed over 7.4 milIion publications to the 6,000 BCHS-supported clfaic~ and in response to public inquiries. Six health education and infor- mation services bulletins are issued annually, and a 1979-80 catalog of approximately 1,000 Feder- ally and privately produced print and audiovisual materials is being distributed. Family Planning Media Projects. Two media projects were run in 1980 by the Office of Family Planning, BCH~., to motivate adolescents to think and act responsibly about sex: one on the dangers and difficulties of teenage pregnancy, and six weeks later, a second, a series of messages about peer pr~sure and sexual responslhility. Four television PSAs will he produced in 1981 to pro- mote communication between parents and their children about human growth and development, reproduction, and responsible decision making. Data will be collected on station use, estimated audience, and the number of write-ins received by the National Clearinghouse for Family Planning Information, Maternml and Chgd Health and Cd0pled Children's Servlees Research Grsnts Program. The Maternal and Child Health and Crippled Children's Research Grants Program currendy funds about 50 active research grants. During 1980. the program continued to focus on research in the delivery of health care to mothers and children; adolescents; nutrition; the study of man- power for care of mothers and children; and the dissemination of research findings. In March 1980, the University of Colorado Health Sciences Center School of Nursing, a grantee under this program, published a report entitled parental Preparation of Preschoolers for Hearing and Vi- sion Screening. The reporl emphasizes the impor* tance of screening as a prevention technique and evaluates proposed solutions to the problems most frequently encountered in attempting to screen preschooIers for hearing and vision problems. Primary Care Research and Oemottstradoa Projects. The Office of Rural Health has spon- sored a series of projects cmphasizfag health edu- cation and the development of self-care skills to reduce risks and oromote prevention activities among individuals ranging in age from children to the eideriy. One such project is designed to sup- port health promotion and disease prevention for the health underserved in rural Alabama and to design and implement education programs that cmphaslze the importance of identifying, coordi- nating and integrating existing primary heahh 57

service programs. The intervention program con- sisls of a medlcal model focusing on reduction Of uncontrolled hypertension and an educational model focusing on individual health care practices. Health promotion Ag~sment Guide. A~ a companion to Promoting Me~fth/Preventlng DIseese: Objectives for the Nation, BCHS developed a guide to help personnel at primary care centers evalaate their heaRh promotion pro grams and initiate new activities in light of the ob- )ectlves. As part of their commitment to Jmprov- trig the health of the community, ambulatory cttre centers are in a unique position to assess, plan, and implement Deal activities encourage healthy behaviors. The guide provides ideas about new ap- proaches to health promotion as well as references 1o national and local resources, Hypertension Services. BCHS provides grants to States for hypertension detection screening, referral for treatment and follow-up for persons ' with high blood plessure. The program expanded in 1980 to increase the number of people served and to establish better foUow-up systems. BCHS and Ihe Natlornd Heart, Lung. and Blood Institute are planning to undertake five demonstration IX'Picots for Black and Hispanic populations based on the recommendations of the Black Health Pro- viders Task Force and the findings of the Hypertension ~ection and Follow up Program. Bureau of Medical Services (BMS) BMS provides medlca[ c.~re for merchant sea- men, members of the uniformed services, and selected community groups. The Bureau inclades among its goals the identification of populations at high risk to permit efficient planning of proven tlve h~aBh care delivery. It operates a system of eight Public Health Service (FHS) hospitals and 26 clinics, located primarily in port cities. BMS adnlinJsters the medical programs of the U.S. Coast Guard and the Federal Bureau of Prisons and provides occupational health care and safety services to all Federal empIoyees. It has the re- sponsibility for improving the Nation's emergency medical services through technical assistance and financial support. BMS conducts clinical and basic research and offers training for health professionals. BMS Prevention Highllght~ Employee Health Hazards, The BMS provides continued assistance to Federal agencies in identi- fying environmental problems that cause employee illnesses. In FY ~0, the Division of Federal Employees Occupational Health (DFEOH) of BMS conducted studies of such employee complaints as liver dysfunction, cardio- vascular problems, respiratory illness, dermatitis. loss of hearing, and workplace allergies. New studies involve the Environmental Protection Agency in Wa~hltlgton, D.C., where employees complained of illness caused by an unknown ele- ment that may have resulted from a camera prOC- essor. Currently BMS is investigating the high degree of cardiovascular disease among employees of the National Oceanic and Atmospheric Admin- istration. The DFEOH provides the services of a professional industrial hygienist who serve~ as a consultant to project officers and as principal in- vestigator for various Federal agencies in conduct ing epidemlolagical studies involving workp!ace exposure. 58 ii __ . Center for OeeupaBonal and Environmental Health. The creation in I979 of a Comprehensive oeci~pational health servlc~ is the result of a coop- erative effort between the Baltimore PHS Hospi- lal and the dohn~ Hopkins University School of Hygiene and Public Health. The program has three unilsmone to ~nvesBgat¢ environmenta[ hazards, a second for positive ~dentification of toxic agents, and a third to treat patients. The service aid~; community-based Federal agencies, private industry, and the National Maritime Union (AFL CIO), An interngeney agreement be- tween the USPHS Hospital in Baltimore arid NIOSH will support development of the Center in FY 1980. 1981, and 1981. Division of Hospilals and Clinics. Disease pre- vention measures are applied in a variety of ways at indlvldual hosp{Lals in the Division of Hospitals and Clinics. Included are activities such as the following: • A new grant from the Council on Aging helps to provide special luncheon programs in Boston featuring speakers who talk about personal health management subjects to the elderly in the community. • At the Norfolk USPHS HospltaL an agreement is being developed with the Department of Housing and Urban Development to fund and revltatize a now!defunct immunization pro- gram for inner¢ity residents. • A novel patient education activity at Nassau Bay Public Health Hospital utilizes closed cir- cuit television in patient waiting rooms, where various health education programs arc telecast for 10- to 15-minute periods throughout the day.

• The Bahimore Public Health Hospffa] i~ col lahoratlng iF a smoking cessation project funded lhrc~u~ Jobr~ Ho~kbls H~ital Indian Health Service (IHS) The Indian Health Servlee aims to elevate the health of Native Americans to the highest possible level al~d tO pr~ide the~ citize~ with o~portuui- lies for defining and meeting their own health needs. The IHS operates a comprehensive health ~.er',~iees system that provides health care for over 750.000 American Indians and Alaskans through a network of 51 hospitals, 86 large health centers, and more than 300 field ¢[inlcs. The IHS empha- sizes prevention through research, dissemination of information, and delivery of preventive SCrV[CC$. IHS Prevention HighllRhts Office of Alcoholism Program~. Alcoholism is a prot'ainent health problem for American In~ dians. As a result. Title n of the Indian Health Care Improvement Act requires the IHS to assume responsibi/ity from the National Institute on Alcoholism and Alcohol Abuse for support of Ar~erica~ Indimx and /kla~g~ Native ~[coh~li~m programs The Office of Alcoholism Programs is th~ resptmsible nail For FY Iggo and FY 1981, 13~ programs total~rtg $I5.2 miRioo have been transferred to [HS, Of the ~75 recognized tribe~ eligible for health care services, it is e~timated that lzM are receiving ~]coho]islla services. Approxi- mately $935,000 was allocated by NIAAA in FY 1980 for the funding of 33 new Indian alcoholism programs directed toward women and youth, Immunization Initiative. In accordance with the overall DePartmental immunization initiative, the IHS objective for immunization is to fully immu alze 90 percent of Indian children under 27 months of age against diphtheria, tetanus, pertussis. polio, measles, mumps, and ru be[In. At the begin- ning of the IHS immunization initiative, the im mualzation level (total number appropriate for age) was 60.8 percent. By June 30, 1980, the im- munization level (total number appropriate for age) was 87.2 percent. Nutrition. At least 30 percent of the American Indian and Alaska Native patients in maternal and eh~d b~al~b ~lir~ics ~r~ %,trt~om~ of t~al~utr[- tion. particularly anemia, low zinc and vitamin A levels, ohe~by, and underweight. In the popula- tlort a~ a whole, diabetes and obesity ta.~k a~ the outstanding nutrition problems. AleohoIism is a major health problem concomitant with malnu- trition. Ten percent of the Indian popuhllion are elderly and are facing the problems of limited in- come and restrkted mobility, which affect their nutritional stattls. Efforts to address tho~;e prob- lems include the foi]owlng: two projects on the Navajo Reservation providing the llece~ary research hascilne for low levels of zinc atld vitamin A among prenatals, lactating nlothers, and pre- schoolers; [unding of 28 State Indian agencies through the Women, Infant, and Children's pro- gram (WIC) to provide services to over 15,(~0 par- ticipants; development of maternal and child health modules at the Nutrition and Dietetics Training Center for use by tribal personnel em- ployed in nutrition programs. National Institutes of Health (NIH) The Nationa] Institutes of Health (NIH) ad- minister a comprehensive research program to improve the health of the American Public through acquisition of new knowledge of disease. A federation of organizations containing 11 In- stiTutes of Health, each with its own medical focus, NIH includes other entities within its struc- ture: the National Library of Medicine, the Ctinical Center (a hospital research unit), Ihe Fogarty International Center, and several ad min]strativ¢ support divisions. National Institute on Aging (NIA) Ag0~g i~ a~eiated ,.v i *. b th¢ o~t ~f Ixumerous pathological states. Moreover, economic, social, and psychological factors generate eircnmslanoes that can ~xcl~dc. old~t p~t~on~ from prodttetivc and satisfying lives. In addition to condt/ctlng fun- damental studies of the aging process, NIA has the responsibilit~ for biomedical, social and behavioral research and training related to the special problems associated wlth aging.

NIA prevention Highlights Conference on the Risks and BeuefiL¢ of Estrogen Therapy. Estrogen therapy has proved useful against menopause symptoms and possibly use eopor osJs (a form of bone disease), but it is also associated with an increased risk of uterine cancer. A consensus development conference NIA held in September 1979 attempted to compare the benefits o[ estrogen therapy with the risks. A summary document of the conference is available from NIA. Data collected subsequently by NIA reveal that estrogen use has declined sharply. Study o| Exercise and the Aglng Process. In 1979 NIA established a program on exercise physiology that will examine aging-related changes of the museuloskelatal system and deter- mine whether exercise can be used to maintain health by regulating these changes. An objective of this program is to provide new information about and understanding of the role that exercise or the lack of it may have on the health and qual- ity of life of Ihe elderly. One project carried oul at the University of Wisconsin has demonstrated the effectiveness of exercise in stimulating bone accre- tion of humans above the age of 55 and thereby countering the effects of osteoporosls. Ongoing studies are directed at women aged 40 to 65 years, an age range during which the most critical bone lOSS occurS. Study o| Human Adaption to Life-Cycle Change% How human begins adapt to life-cycle changes in later life is the subject of the Duke Adaptation Study. Begun in 1968 as the second of two Iongittld~nM studies, 11 focused on 502 par- ticipants (aged d5 to 69 when the study was ini tinted) to find the answer. The sludy concluded 60 that participants who had reduced psychological resources (low intelligence, high anxi~y) were most likely to experience stress from events such as illness, widowhood, retirement, or a lasl child leaving hone. Among 1he majorlty of partici- pants, mos~ of these st testes had llt tie sited fieance. indicating that life-cycle stresees have less in- fluence on older individuals than l~reviously thought, National Institute of Allergy and Infectious Diseases (NIAID) The National Institute of Allergy and Infectious Diseases conducts and suppo,-ts research contrib- uting to a better understandingof the causes of allergic, immunologic, and infectious diseases and to the development of better means of preventing, diagnosing and treating illness. The Institute con- duets studies of the diagnosis, treatment and prevention of all types of infection, including research on antibiotics, antimicroblal and anti- fungal therapy, antlviral substances, antisera, and vaccines. NIA1D Prevention Highlights Conference To Develop a Consensus on the Use of Amantadlne for the Prevention and TRatment of Influenza A, Epidemic Influenza A is clearly associated with excess mortality among the elderly, ly. and costs of a pandemic year may total $5 or $6 billion. Costs in interpandemic years are measured in the hundreds of millions. In October 1979, NIAID sponsored a consensus development con- ference of amamadine, an antriviral agent that show~ hldieations of usefulness in the 0reventioa and treatment of Influenza A. The conference brought together scientists, health practitioners, and consumers to review current knowledge in these areas. Their final recommendations are available in an NIAID rel:~,rt entitled Consensus Developmerlt Conference Summary If: /Imanto din~ Does It Here a Role in 1he Prevention and Tre*ttmen¢ of lnfluenze A ? Gonococcus Vaccine Developmenl Contract. Gonorrhea constbntes a major public health prob- lem in the United States. In 1977 there were an estimated 2.5 million cases. In 1979, NIAID con- tracted for the development of a gonococcus vac- cine that. if Successful. could prevent gonorrhea and related complications, such as pelvic inflam- matory disease, sterility, and fetal and infant deaths. New purification procedures for the isola- tion of principal outer membrane protein (POMP) of the gonocoeeal cell were developed; these resulted in POMP of greater antlgenicity and in 4n-fold higher yields. Hepa¢it/s a Yacclne T~abs. Hepafiti~ B is a viral disease that is spread through blood transfusions, sexual contact, and transmission from mother to unborn child, There are 200.000 chronic carriers of Hepatitis B in the world, including an estimated O. J percent of the populalion of the United S~a ~cs. In 1979. NIAID supported a study of the efficacy of a Hepatitis B vaccine in two hlgh-rlsk popula tions: a group of volunteer subjects undergoing renal dialysis and the staffs of dialysis units in New York City. Another study is testing the eh~- cacy of Hepatitis B immune gobulin in preventing transmission of the virus from mother to fetus.

National Institute of Arthritis, Metabolism, and Digestive Diseases (NIAMDD) The National Institute of Arthritis, Metabolism, and Digestive Diseases is responsible for a wide variety of re~earch on disease related to ardlritis, lhe muscul0skdetal structure, the bone and skin, the endocrine system, the dlgestlve tract, and the urogenital tracl. The Institute is concerned with diseases for which the cause~ are unknown or poorly defined, and in these areas concentrates its prevention efforts in basic r~earch ~txld~es on causation and pathophysiology. The following nutrhion areas are emphasized: obesity, suppor live nutrition, dietary fiber, metabolism and mechanism of action of nutrients, interactions and factor~ that n~dify rxutr~tlortat requirements, and trace element nutrition. NIAMOD Prevention Highlighls Recommended Dietary Allowances. The establishment of standards for nutrient needs is a difficult procedure, but one that has direct impor- tance in the maintenance of optimal health. The Recommended Dietary Alfowanees (RDA) established by the Food and Nutrition Board of the National Research Council serve as national standards. The Board, with the support of NIAMDD funds, draws upon experts from a variety of sections who serve on ils Committee on Dietary Allowances for all nutrients known to be essential for optimal human health. Adherence to this set of recommended daily dietary intake guidegnes provides the amount of nutrients and calories adequate to nourish most healthy in- dividuals in the United States. The most recent revls~ort was released ~n 1980. Nutritlon Program. Recognizing thai the essen- tial nature of an ever-increaslng number of trace elements is of considerable concern, NIAMDD research has emphasized the metabolic rote of stlch lraee elemenls as zinc, fion~ chromium, silicone, and fluorine to determine tbeir essential- itv to health. An important flnding in this area eoneern~ the role of the amino acid ryrosine in lowering blood pressure in rates. Other studies have established that the mineral zinc prevents growth retardation in young children and im- proves ~perm formation in men, the elemenl silicone improves collagen formation in blood vessels, and the element chromium make~ a slgnificant contribution to lowering blood sugar levels. Researchers have also developed a substange that can be taken oragy and could he in- strumenlal in preventlng various urea-cycle deficiency diseases. National Cancer Institute (NCI) The National Canter Institute is the central coordinating agency for the national researeti el- fort against cancer. It funds and conducts scien- tific research and the training of scientists and makes cancer information available to scientists and to the general public. The NCI prevention initlati~e ha.~ three principal objec'tNes: develop- ing substances that interfere with the process of cancer formation, identifying cancer-causlng substances and behavior, and educating the public to minimize their exposure to such substances. NCI Prevention Highlights Use of Uetinoids in Cancer Prevention. Studies indicate that retlnoids, the set of molecules com- prised of Vitamln A and its synthetic analogues, may prevent the development of some forms of cancer. One drawback to the widespread use of retlnoids has always been their toxic side effects. Floweret. NCI has made progress recently in the development of new agents that are le~s toxic and can be more accnrate]y dlrected al spcciflc organ sites, such as the lung. bladder, or breast, where preventive action is desired. Their" increased potency rcsnhs from alteration of the pattern of tissue distribution of the retinold moIecule. Cur- rent a¢livitles include development of g project to assess the use of topical retinolds in prevention of eelwlea] c~ncer. New Research on Cttreinogcns Working in Tttndem. The deveInpmen~ of cancer can he potentiated by exposure to several enviconmenta] agents, either at the same or at different times. I~g amples include: asbestos and smoking for lung cancer; smoking and drinking for cancer of the oral cavity, pharynx, larynx, and esophagus; and the copper smelting chemicals sulfur dioxide and inorganic arsenic for lung cancer. An important laboratory finding in this area is that pretreatment of cells by X-irradiation, or by an alkylating agent such as methylmethane sulfonate (MMS), results in an increased number of cell transformations if the cells are subsequently treated by any of a vari- ety of carcinogens. Under the experimental condi- tions used, t be X-ray pretreatment alone produced no transformation, and the MMS alone produced only rare transformations, Another significant" finding of this study was that the enhancement of transformation by X-rays or aLkylating agents is independent of whether the cheraical carcinogen subseqnently used is a Dolyeycge hydrocarhon~ another alkylating agent, or a compound that pro- duces effects slmiIar to those of ult raviolet irradia- tion. 61

Research on Biological Respohse Medirler~. Currenfiv there is high interest in biological response roodiFiers a group of snh~latlce~ that can alter the developl~er~t and progr~ss~orl of cancer. Perhaps the be~t known i~ interferon. |rt FY 1980 the Divls]on ol Cancer Treatment [urlded a prOject in Tany~nla~ to as~e~s the effects ol cherrloprev~/ltion On the formatiorl of skin cancer in ~lbinos, The inciderlce of cancel will be cor- related at monthly intevaLs with exposure to the snn~ In addition, compounds that have been ap- proved for hunmn use will be letted on the patient popt#)afiot) to determine their effccllvene~ i~ reducing tbe incidence of ski~ cancer, The k~owledge gathered here wlil have implicalions for the preveiliion o~ ,skin cancer ]n 01her people wlth little or no p]gmenL such as North Americans arid Europeans. it~ whora skLq cancer is by far the rnosl fret/t~ent Cancer. Dietary Role in Cancer. Accumulated evidence sogg~t$ that dlet may play a role in the causation of ¢¢rtalu forms of cancer. I)a~a ffo/r~ epidcgnfa- logic arid att~ma~ ~tndles suggasl roles for f~t and Jibe," it] the eausa~01~ of catlcer, bul those rol¢,~ have yet to be defirled; arid i~ is riot oow ceftaln how chat~ges hl the intake of fat ~l~d fiber might conlfihtlte to preventlot/of cancer. Olber dietary faeto~ trader ~nvcsdgalion for their faYluer~ce in enhancing or inhibhir~g cateinoga~esis include: total cnloric balance; vitamins (especially A, C, and E); minerals (~peclally selenium and zinc); and naturagy occurriog compounds (such as l~'st~- tides, prcserv~l~t~, ~a.~ofing arid coloring agents, and packaging materlals). Whde there is rio presetx~ indicaliort tha( the~e ~lasscs of tutti- pound Ca~lSC Can~er, the N(SI is asscsshtg these artd tllanv oth~r eheraical$ f0~d ig the etl~irort- ment to ascertain their potentla~ for doing so. CON'~eIlSlI~ On PIIp Sm@at'g. A Co~en~kls Development Conference on "Cervical Cancer Screening; the Pap Smear" wa~ held at the Na~ tlonal Inslitutes o~" Health in July 1980. The pur- pose of the conference was lo examine th~ scion tiflc be~i~ for screening for ¢ervlea] cancer and to make r~commendafions to the medical communily and the public on the use of the Pap smear h~ serecnlng for cancer of the uterine cervix. No attempt was made to provide recommenda- tions about Pap smear ~creening for other car~¢¢rs of t he female genital tract ~i.e.. endometriaL ovar inn. hormonal). RecommendallOn~ were btlsed on screening procedures as appiled tO healthy female popu]atlor~s and not to women identified a~ patients undergoing gynecologic treatmem. In addition, some of the ¢r~dca] unar~wcred ques- tions were idemif~ed. Dendls of the reeommendz- fiom may be obtained from the Nadonal Cancer Institute. National Institute of Child Health and Human Development (NICHD) The National Institute of Chlid Heahh and Human Deve[oprtl~rtt conducts and support~ research On the reprod'actlvc, dev~iopmentai, and behavioral processes tha~. determfae Ih¢ he.allh of children, adults, families and popula~iot~s. The NICHD is commfited to the prlnc~ple tt~a~ the e[ffIiest phases of life offer exc~plioria[ oPpor- tunlties to prevent disease and disability that ctm affect people at any time in their [ive~; and lhe [n- siitute emphaslzqs primary prevention, wherlever possible, to intervene before b~olog~ea[ a~d beh~vlorgl probl¢~ emerge. NICHD Prevention lllghlighg~ New Program on Behavioral ~nd C~B~rsl Aspee~x of Nutrition. In FY 1980 the NICHD spent more than ~2 mig)on Oil a program of re,earth on behavioral a~d cultural infhJences on nuir~don, to determit~e the effects of diet and other nulritiona] influences in childhood on later development of disorders sl/ch a~ obeshy, diabetes, hypertensloil, and heart disease. The restdts are expected to have important ]mplk:a- tlo~ for these disorders and for ar~ficipaOog prob- lems caused bj' allergic or idiosyncratic reaedo~ to ¢ertai~ food~, such as milk. sugars, wheat, soy- beans. Java beans, and various food additlve~. E~pha~is in lhe program is given to behavioral~ scciocult~ral, and genetic inf/uences on dietary patterns, ta.~t¢ preferences, and fond aversions. $1udy of ~be ael~tlortxMp Between Oral Con. Iracegfives ~nd Heart AttaCks. Ar~ NICHD stndy fafilated in ~h¢ mid- 1970~ ha~ discer t~ed ao incr¢as. cd inclde~¢¢ of myocardial il/faretion atr~aog womet~ of chlldbeaeirtg age who take contraoep- tires and who do not be~e diabetes me/lltus, high blood pressure, or other diseases that "#ouJd ~r¢- dispose them to heart aftachs. The data mo~t cited ~ugge~t that the overall risk for a first myocardial infar~ion in premertopaosal women who used oral contraceptives in th~ preceding month is four tiftle~ that for womefl who do not tt~e oral ¢oo. tractpfiv~s. Women who smoke more than 2~ cigarettes a day and who used the pill in the prgcediflg month were a/so noted to have 39 times gaeater risk of myocardial in faretion than women who neither sraoke nor use (h~ pill I{owevtr. the data do not show significant numbers of fatalities. and no increase was found among women taking oral eontraeepfivcs who were already predisposed to heart attacks.

S~'edy of tha R~lgfiottshlp Bt~we~ Oral Contra- cepfives trod High Blood Pressure. Using oral con- traceptivcs did not increase the incidence Of high blood pressure among women who par tiei!0at ed in an NICHD ~tndy begun in lhe mid-1970s. The ~tudy reve~led no differences in fam~ly bi~tory, irt clinical and laboratory charaeteristlcs, or ifl the ~pontaneous or therapeutic reversibility of high blood pressure ~etween nsers and nonusers of oral contraceptives. Study o[ the |tormonal Effects of V~.~ectomy. V~sectomies had no significant effect on hormone levels in 203 ma~es who pard~pated in a recently eompfeted NICHD study, irl the study, blood levels of testlcuIar and pitultllry hormones were checked before surgery and then monitored for two to three years afterwards. Patient hormone levels did not chang~ ~gniflcalttly during tbi~ time, Conferent~e To Develop a ConseRsus on "reck. ni0ues for Prebirth Diognosis, The N~CHD Spon- sored o. conference on the ~.t'ety ~.txd efflc~tcy of techniques used in prehirth (antenatal) diagnosls. The conference brought together physicians, bio medical researchers, consumers, and others to review the techniques used in p~dlcting hereditary disease, fetal age, and fetal distress. These tech- niques included atoniocentesis, pulse-echo $ono- graphy, fetoseopy/plaecntal a~piratiog, creatlnine concentration in amniofic fluid, p~ospbol~ids (pulmonary maturation), and electronic fetal monitoring and fetaZ scalp blood pH determina- tion. Terl thong, and cop~es of the full report of the NICHD, Consensus Development Conference SL!l~ttHu~ on hrlr¢~ot~ D~osts. ~ele d~elb- uted to a wide range o[ health professionals, and conference recot~nmendation~ were also dlssemi nat~ through journal articles, National Institute of Environmental Health Sciences (NIEItS) The National lnstltut¢ of Envlronmet~tal Health Sciences supports and conduct!, re~earcb on the ef- fects of eavironmenlal agoras on human health. seeking ide~tiflc*,tio~ of ehet~ic:~l, physical, or biological agents or disease before they are releas- ed into ~he environment. Through this research. and through manpower training and information services. NIEHS assists the many public and private organizations that are also cot~¢erned with links between environmental factors and disease, and provides the scientific information base need- ed by regulatory agencies concerned with control Idlg environmem~d hazards. NIEHS prevention Highlights Natiotml qFoxi¢oleqty Program. The biafional Toxicology Progt'am (NTP) was established in FY 1979 as a cooperative endeavor among four DHHS agencies (N[EHS, NCI. FDA. and CDC/ NIOSH) to develop scientific information to pro- ~eet the health of the Amedcat~ public from damage by exposure to environmental chamicats. During FY 1980, the NTP eontlnued r¢search and management activities in support of the four specific goals of the program: (1) to broaden toxi- cological characterizations of chemicals that are tested; (2) to increase the rate of chemical testing; (3) to deveIop and validate a series of protocols appropriate lo regulatory nccdsl and (~) to ~m- prove and expand generation and dissemination of hlforma~ion Coll~erning lest results, method development and validation, and other program activities. As part of its commitment to NTP, dur- ing FY 19g0 NIEIAS ~es~ed agDrt>xit~at~y 390 ¢hel'i~icalx for genetic toxicology in ~a/munella. All chelnicals selected for NTP*s lifetime carcino- genesis bioassays and for testing b~ its general toxi- cology ~creen are lested lirst in this system. The Salmonella test system is also being used ~n an in l~ela.hc*ratory ~udy ~ dctermi~xe the ¢orrelaL[otx between carclnogenicity--a~ measured by the life- rime bioassy--and matagen~eity. Sludy of Agent Orange and lls Contamitmnl IDio~n. As concern has me*unreal amo/lg several thousand Vietnam veterans who feared health ~f- feels [rum possible expostlre to Agent Orange (one of ~h¢ her hicide~ widely used as a defohant in X~iet - ham in the late 1960~). the President, the Con- gress, and the Executive Branch have sought solu- tions. To thi~ end, during FY 1979. DHHS started a program to focus biomedical, clifllea], and epidemiol~gic s~xadies t3rt the ~Ix~flc damage caus- ed by Agent Orange attd other herbicides contain- ing dioxin~. This program is directed by the DHHS Committee to Coordinate Environmental and Related Programs (CCERP), chaired by the NtEHS Director. A male anlrrta[ reproductivlt¥ study was initiated in FY 1980. Recently, NIEHS/NTP reported that it found no evidence of germ cell toxicity or adverse effects in the development and survival of offspring as a conse- quence of paternal exposure to simulated mixtures of Agent Orange. These results were forwarded to the President's lnterogeney Work Group to Stttdy the Possible L~mg~erm Hetdth Effects of Phenoxy Ilerbicides and Contaminants, Study of Contsmin~tlls in Mothers' Milk. NIEH$ has begun $ s!udy to determine how'much and what kind of environraental eo~t~amluatiot~ infants are receiving from breast feeding. Previous studies have already found that breast milk can be 63

contat~ldated by chemieols. One such study detef- mldec] that most mothers in the Southcasterr] ~oltcd States carry detectable amounI~ of the ~cstieidc DDT and that more than two thirds of the nlilk samples contained at leasl trace amounts of the family of insulating ¢hemieals called PCBs (polychlorfaated biphcnyls). NIEHS hopes that the new study, which favolvcs paI~13t voltlntcers at hosplt aI~ il~ North Car olin~ and which wi][ corn pare breast- fed in fa~]ts with tho~c fed on commer- cial forl~inlas, will rcveal wh~thcr or not there arc chemicals ld the foods these babies receive afld+ if there arc, what ¢ffect~ the chemicals have on the children's lollf~-term health and development. New Inv~tlgalor and Mid-Career Tr~ini~ Pro- gt'ams, A.s a new zcicttcc, ¢rtvirorLra¢I1t~l health iz not well established within the fastltutldns that train th~ Nation's clinical and biomedical in- vestigators. NIEHS h~.~ d¢'~¢foi~d t~cJ ~.~ra~ dcslgncd to close these training gaps. The first program, cntitied the New Invc-~tlgator Research A.w~rd. i~. de~i~cd 1o ~sA~ act ~o~g in'#csli~'Lc*Ts. The second training effort, cldied the Mid-Career Development Award Program. is designed to reach bioch~m~sls, phatmacologlsts, physio- logists, and other scientists ~tnd to provide them with career devclopm¢llt c.pportuoltles in en- vironmental toxicology. In FY 1980. New In- vestigator Awards h~ve been made to 44 recipi- ents. Trafalng i~ beldg carried out at universities throughout the country, including the University of Maryland. Yale. SUNY, Oregon Slate, Co~neIl. Texa~. Oklahoma. Washi~Igton. Washington Stat~. M[ehlgan State+ Stanford. Emory. and UCLA. 64 National Eye Institute (NED The gc~t of NEt is to work toward the cllmlna- finn of the major causes of blindness and visual d~abilitv, The [nsti~te sup~ports research on the fanctldnfag of fac vlsua] system, the [Jat hology of visual disorders. ~2nd the sciences supporting vi+ ~ldn research. (f~ ~.Iso s~z~or~ rcs¢~.~ch ~31~ the prevention and treatment ~f visn~] disorders. fo~ters studie~ of the rehabilltation of the v~st~al]y b.~t~dic~pped. ~d cr.cc*~ir~gc~ cli~ica~ ~,plie~>n of rgscarch findings. Moreover. NEt aims to heighten public awaren~s of visldn problems thrr~ngh fa~ormafion p~ograrns and coo~)crate-~ in h¢old~ campaigns ~nd other projects s]pnnsorcd by volunteer organ[zatlons with similar ¢oncvrns. NEI Prevention Highlights New Consensus Opinion on Lens Implants in the Eye. A recent NEI conference on lens implants in th~ eye corlcIuded that thc~e operations should be restricted to elderly cataract patlerl~s and to one eye on]y unless specific n~'¢ds dictate othcr~'ise. The ~'o~lscnsus development panel in Intraocnlar Lens ImpIantatldn (IOLS) added that tens implan- [atldn "may be t~sed for younger patients only if contact lenses or eyeglasses at'c not likely to boost the wear~r's function," Currently, one qnarter of the estitnated 40~,0~0 eatarRct opcratldns per- formed aaanaU~' ia tl~c Unlted St~tc~ involve im I~[ant~tlon o~ intraocvldr lenses. Th~ summary of the c~nsensns was reeently published. Prevention and/or Control of Eye Diseases Related 1o Nutdliollal Deficiencies. ImproPer the eg~. The ~ack of essential s~bstances such as proteins, ~arbohydr~.tes, fats, m]tlcrals, and vitamins may produce spccfi~¢ deficiency symp- toms. A study currently ~npportcd by the NEI relating In cataracts is directed toward ldentl lying ~lutrienl risk faetor~ ~n ¢~taractogenes~. One ~EI intran~ural project a~ms to determh~e Ihc bio- chemical basis for Vitamin A-mediated changes in cornc~I epithelium. Another intramtlraI pro~ect has been d~igncd t() ¢:~ami~e the infIuen¢~ of rhodopsld (V~tamol A + opsln) on structural alteratldns induced by light. This project is testing the hypothesi~ that rhodopsfa is involved in in~+ tiating the proecs~ [cadfag to the struetura] deterldratlon of retina] photorcceptors. Ffa~l]y, the NEt supports an intramural p~o~cct to Iv.ar~ how ocular diseases involvldg Vitami~ A metabolism can be prevented or treated, once they b.aw deve|~ed. SpcciE~at[y, th~s p~cc~ i.~ at- tcraptldg to clarify the mcchanlsm of action of retinolds in ocular tissues. Use of Vitamin E to Prevent netrolental Fib ropl~ia. With the judiciott s limitation of oxy- gen therapy }n the newborn, the ldciden¢~ o1" retrolcnt~l f]brop[as~a, once the leading Caus~ of blindness in children, has bc~n dramat ieally reduc- ed. Nevertheless, because o~" the difficulty of precisely and continuously mc, nitorld~ blood oxy- gen l~vels and because of differences in retina[ vascular sensitivity to oxygell, this disease ¢on- tinnes to cause blindness. Since there is evidence that Vitamin E ~ffects the ¢cllldar defenses agaldst oxidatlvc damage, it~ clinical effect under cofldi- tlons #)f carefolly cont rolled oxygen therapy is be ing testrd in an NEl+sponso~ed clinical trial of over 650 infants at three hosI~i~als. fov~fig.~tio~ of the Effects o[ Drag% Light, and Envlronnlental ~;uhsI~lnccs in ~etfaal ~nd Lens Disorders. The effects of light, drugs, ~nd envlrol~men~a] hazard~ upol~ the rc~ina and lens

,are being studied One projeet is designed to clarify, further the role of near ul.a~fo[e~ ligh~ in ocuTar tissue damage. ~pecifically. the role of ,unli~hl a~ a f,qclor in human retinaI and lens pathology, and Io test the efficiency of antio×i- danls and free radical scnveTIgel~ hi preventing ~hls daTnage. Prevention of Reeurrenl Corneal Infe¢lion from Herpe~ Simplex Virus. P, ecurretlt herpes simplex kerathis is a major cause of morbidity and visual Ios~ in humans. At the present time no reliable means of preventlng recurrence Of this di~ea~,e exisl~ Between episodes, herpes virus appears to reside in some form in the nuclei of the trigeminal ganglion¸ Cliqlical ini- dalor~ such as febrile illness, emotional s~rcs~. ~nllght. and trauma have been associafed with ~he recurrence of herpes keratitis, in all such in- stances cellular cyclic AMP is elevated, either through synthesis of prostaglandin~ or epinephrine release, NEI-~upported re~earch is attempting to clarify the m¢¢hanlsm of herpes recurrerlces by study of cyclic AMP ~timtllators and inhihilors in an animal model. A better underslandlng of the mechanism of recurrences will lead [o clinical therapy to prevent devastating corneal disease. Prevendom of Trachoma and Related In- fectious. The goal of thi~ re~¢arch is the preven- tion ol control of trachoma, lhe Icadirlg cause of blindness worldwlde, a.d of other diseases caused by infection with trachoma or cfo~elg related organisms, fovesdgations supported by NEi are dlrected at improving lmmunocla~si~ca- llon of [he~e orgmdsms, determining their blo- logical characteristics, and isolating and describhlg chemically thelr antigells. The role of a genital reservoir for trachoma organlsm~ i~ be ing evaluated in areas of trachoma endemicity on I aiwall, in areas [to ioi1~e[ ¢2r~dem~c [or [rae~ovfla in Taiwan, and in the United States. Pre~elllion of Proliferalive Retinopmlhfes. Did.eases ~uch as diabete~ that ~mpair retinal function by affecting the retinal vessels i. variably do so by ¢auslng blood vessels [o close off. leak. or grow abnormal, fragile offshoots thai bleed. The NEI is supporting invcstiga- lion~, including cllnical trials, aimed at under- standing, preventing, and correcting the pro- liferative retinopalhie$ and cednal vascular disease in general. Development of Chemieal~ lhat lnidblt Produ¢lion of Aldo~e Reductase. ;in Enzyme that Trlgger~ Sugar Calaract. The discovery that aldosc reductas¢ triggers the events that lead to sugar cataract formation is the basis [or the development of several inhibitors of the en zyme to delay this cataract formation process. These inhibitors have been succes~follv tested il~ laboratory animals, and ino$1 recently one new inhibitor has been sho'~n to be completely ef~ctive in blocking cataract formation in diahedc animal~. This research has implications not only for the possible preventlon of human diabcdc eataract~ hut aIso because aldose reduc- lase has been implicated in the causation of other diabelic complications, for the alleviation of diabetic neuropalhy and retinopathy. Re~earch Aimed at Prevenliou of Amblyopia and ~lyopia. it has now become possible Io TII~IMI I ~7 Vi~IlU[ al:ui[ y, (~olo[ visiOll, az]d eye move- t~]ent ConlroI ill i~fants les~ thal~ ~ix month~ of age. Fhe~e analyses shoul$ enable the detecl~on of such disorders as strahi~mu~ and amhlyopia al much earller stages and earlier initlation of ap- propria~e Irea~ment, t hereby l)reventi~g los~ of vi- ,,ion. NEI h~ts awarded One ~ranl ~o track Iongi- tudinal[g the mofocular visual resolution capabilities in es0tropic tero~seyed) infant~ before and during therapeutic management, Results ~o far indicate that the human visual nervou~ system i~ highly ~u~ccplihle to modificatlo~ by esotropia and short perlods of occlusion during the first year of life, Under anolher NEI-supported grant, an attempl i~ being made Io characlerize the mor- phologic change~ in Ihe eyes of chicks as myopia develops Io help prevent this disorder in humans. Another NEt grant fund~ re~earch into whether alI overeorrcctlon of optlcal lens power for children wlth myopia w~ll slow down 1he rate or increase hi myopia. Prevenlio~ of Glaucoma. Impressive progres~ has been made in recognizing Ihe causes of and in diagnosing and lreating angle-clo~ure glaucomai however, earller diagnosi~ could substantially lower the incidence of vlsion los~ from thi~ disease. DeveIoping a means of identifvlng people wilh antlttlmic predi~po!,idon~, 1o angle closure glaucoma, who are al greatest ri~k of acute attack and Io~s of vision, would help achieve the g0al of prevenlion. All attempt is being llladc to deter mine the association between loitered blood pressure and the presence of glaucomatous like visual Field defects. A significant association be- tween blood pressure reduction and visual field defects would have seriollS implications for the current mode of therapy for syslendc hypeflen- sion. Finally. anotller NEI supported grant is con- lrolling the physiology of aqueous humor, If this attempt is ~tlccessfu[, tile resull~ will ~rovid¢ a basis for nsitl~ these drugs in controlling glaucoma. 65

National Institute of Dental Research (N/DR) To improve the oral health of Americans, the National Institute of Dental Research conducts, fosters, and coordinates research into the cause& prevention, diagnosis and treatment of oral disease and conditions. The Institute sulk- ports investigator initiated research grants. research training, intramural projects, and con- tract research and development, in If71, the National Caries Program was established to focus priority support on the development of preventive technologies to combat the major cause Of tooth loss among children, a disease that afflicts more than 90 percent of Americans during their Iifetimes. NIDR Prevention Highlights Demongtraaon projects to Prevent ~footh Decay. Tooth decay is a major health problem in the United States, espealany among children. The National Caries Program of NIDR initiated 17 projects in 1975 with children in kindergarten through the eighth grade, in which over 80 percent of the students in the respective communities par- ticipated in weekly mouth-rinslng with fluoride. Although Federal funding of 12 of these projects was discontinued in February 1979, all 12 received. local funding to continue the weekly rinse regimen. Federal support of the remaining five projects, which now include high ~ool students, continued through April 19go. Results of the original studies are now being analyzed. Media Projects Caries Preventlon. Presently knoteu for prevendve cr~easures can provide significant prolecl]on against the ravages of tooth 66 decay among children. Never- theless, a large portion of the public remains unaware lhat the u~e of f]uoride~ can bring about improved dental health. The National Caries Pro- gram of the NIDR has initiated a vigorous health edueatfon activity to inform both the general pubgc and health professionals about effective prevention of dental carie~ through water fluoridation and through other mcthod~ of fluoride application. Efforts foclud¢ exhibits. leaflets and films. Well over 200.000 cop~es of I he posters and leallets have been dist ribttted. The au- dlence for the film "Reading~ Writing, and Rins- ing," which continues to be used on television. was estimated at 6.2 million in 1979. National Heart, Lung, and Blood Institute (NHBLI) The National Heart, Lung, and Blood lnstilute is the central coordinating agency for diseases of the heart, lungs, and blood. It supports research and professional training in these areas, and pro- vides educational programs for laypersons and health care personnel. NHBLI Prevention Highlights Hypertension Detection and Follow-Up Pro- gram (HDPP). (See ChaDter l .) Public Service Announcements About nigh Blood Pn~xg."¢. A new radio and t¢leviglofl cam- peign has been launched to continue emphasis on the necendty of regular treatment for high blood pressure. Messages with the ibeme "High Bfot~ Pressure--Treat it and Live" have been distributed to teMvisio~ and radio statlons. The public service message is one of the major sources of health information for the America0 ptlbl[c. Previous 'LSDOtS'" on high blood pressure~ given goner nu~ flme by the stations, appear to have con- tributed to improved public understanding of high blood pressure in recent year~. The fostitute will arrange systematic moniloring of these messages over the nex~ three years; nloreover, a trail assess- merit will be made of the effect of media hyperten stun mcssageq On health care I~roviders. ReeommendaBons on Health Need~t of the Black Community. The Black Health Care Pro viders Task Force was e~tablished in 1977 and in eluded representatives of predominantly Black health professional associations and the legal association as well as the E~ecutlve and L~glshRive branches of the Federal government. In 1980, the Task Force issued a list of gO recommendations on the health needs of the Black community. The most important objectives identifled by the Task Force were (1) that between 1981 and 1995, effec- tive control (diastolic blood pressure of less than q0 ram Hgj be altained for at least 50 percent of hyper[enslve Black Americans. and that hi each succeeding five-year period, at least 50 percent of the remaining hypertensive Black Americans at- taln control at th~s level: and (2) that a~ong ~r- sons in the 90 to 140 ram Hg dlas~ie blood pressure range, the percentage be reduced of Black Americans whose hypertension is either un- detected, detected but no1 being treRted, or detected ~md being treated but not under control. Nutrition Counseling Eduellion, The third and fourth of an ihitial series of four workshops on nutrltion counseling were held in Seatde, in May 1980, and Aflanta, in September 1980. These workshops affected an estimated 200 in- dividuals. (The first two workshops were held in

I978 in Newark. New Jersey, and in 1979 in St. Louis, M~ssouri) These workshops were de- signed to help nutrition practitioners improve their counseling skills. NHLBI worked with the American Heart Association (AHA) and used a national network of AHA nutritionists to man age Iocni workshops. The ANA is preparing a how-to-do-li manual to encourage local groups to plan and conduct more workshops' and the NFILBI has in l)rogress a book entitles HEART- TO-HEART~" A Manual on Nutrition Counse! ing for the Prevention of Coronary Heart Disease, a text for these workshops that will be promoted nationally to nutrJtionlsts and dieti- tians. Dielary Conlrol of Lipoproteins. During 1980, NHLEI distributed more than 387,000 copies of "Diatary Management of Hyperllpo proteinemia." This series of publications corn prises a Handbook for Physicians and Dietitians and patient manuals for each of the hyper llpidemias. These manuals will assist the health professional in reducing a patient's elevated lipid level, by diet, to a normni range. This effort has been in progress since ]971. with 7.8 mlilion copies in the series having been distributed. In Fiscal Year 1981, an evaluation of these pub- [icaflons will be made to determine whether revi sion of the presentation of material is warranted and to assess the distribution methodology. National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) The National lnstilu~e of Neurological and Communicative Disorders and Stroke (NINCDS) supports research in the areas of neurologicni and communicative disorders and stroke. Its goals include reducing incidence of hearing, language, and speech disorders, which are estimated to afflict 20 million Americans, and reducing both the incidence of stroke and deaths resaltiog from stroke. Emphasis is also placed on lhe central nervous system as a measure of gaining insight into the unique role of the brain in influencing pathways of central information to metabolic status, through biologleally active substances that inHuence the normal state and deviations from it that constitute the early onset of pathogene~is (prebiologi¢ and preclinical). NINCDS Prevention Highlights New Section on NeurOloxicololLv, A new work unit was created to investigate toxic sub stances that affect the nervous system and to maintain active contact between NINCDS and the National Toaicology Program (NTP), which has overall responsibility for testing hazardous chemicals. In 1979 the Neurotoxicology Section published data on the neurological toxicity of the food dye Red Ill and its structural analogues and the effect of low doses of estrogen on brain function. These results eventually led to clinical studies with direct implications for early detec- tion of central nervous system disorders. The Section is currently supporting intensive research on the mechanisms of toxin-induced changes in the nervous system. The findings of this research will contribute to the early detec tion and prevention of such neurological and communicative disorders as multiple sclerosis. and deafness. New Research Technique (PETI'). NINCDS has awarded about $11 million in FY 1980 to seven national cefltcis to expand research on a new technique called positron emission trans verse tomography (PETT). This technique uses a radinisotope and a scanning device that allows neuroscientists to study the human brain (its physiology and biochemistry) in nivo--that is, alive and functloning--wlthout any tratnnatie in- vasion of its structure or interference in its func- tion. This new, exciting technique wilI enhance understanding of normal brain activity and of the underlying physiopathogenesls of such neurolog ieal disorders as muItiple sclerosis, Huntington's disease, Aizhelmer's disease, stroke, and brain tumor. Division of Research Resources (DRR) DRR strives to improve national research resources, and its responsibilities include help- ing institutions establish and operate general clinical re.arch centers for studying human diseases in patients; increasing and improving laboratory animal faeitldes and resources, such as primate research centers; and providing a unified approach to improving institutional, regional, and national health research. DRR Prevention Highlights Reduction of Alherosclerosis in Monkeys. Dietary studies with monkeys indicate that sup- plements of alfalfa meal added to various diet regimens reduce the extent of aortic and cor- onary atherosclerosis in these animals. Alfalfa meal apparently counteracts the deleterious ef- fect of dietary cholesterol on monkeys, and these findings could be applicable to humans. 67

~9

Other DHHS Agencies Health Care Financing Administration (HCFA) The Health Care Financing Administration (HCFA) provides reimbursement for medical care of the eMerly and the sociotconomleaIly deprived, develops ~nd enforces standards for the quality of heahh care. and conducts intensive efforts to pre- vetlt fraud and abuse in its programs. Medicare and Medicaid are its two major health care pro- grams. The agency ~ncludes in its goals the promo- tion of timely, cost-effective delivery of appropri- ate health care services to program beneflelarfes; making beneficiaries aware of, and assuring lheir access to, the services for which they are eligible; and ensuring that its policies and actions promote quality arid efficler~" throughout the health care delivery system. In lgg0. HCFA. in conjunction with the Public Health Service, intensified its child heahh promotion efforts. Furthermore, health promotion efforts directed In Medicaid and MedJ care adults are being developed, with Public Health Service support. HCFA Pt*vention HiRhllghts Regtl|affon~ for F~mi]y Pfann|ng. All State Medicaid programs are required to provide family planning services. During 1979 HCFA developed new regulation~ for family planning programs funded by Medicaid. These regulation~ permit re- imbursement for counseling, sterilization reversal procedures, and education for natural family planning to eligible Medieaid beneficJarles. The availability of these servicex through Medicaid ..viii contribute to the emotional health of those indivi- duals who need family planning assistance. National Second Surgical Opinion Program. In September 1978 HCFA initiated the National Sec- ond Surglcal Opinion Program (o improve quality of care by encouraging health care consumers to inform themselves fully about alternatives to ~ur gery. add the risks and benefits of treatment alter* natMes~ before deciding whether to undergo elec- dye sL~rget~ This prngr~m al~o seeks to help patients contain costs by fac~lltating discovery and use of les~ costly alternat~ve~ to surgery. It has established both a national network of re,real certterS that provide ph.'¢slcians' names to persons se~klng second opinions, and a nabottal hod~ne. Approximately 1,500 peopM u~e the hotiine numo bet each olonth. lnformtqion Services [or the I~ldeH~ atzd the Yoang. A ~er/~s or" brochcxres erie/deal "'Sei~Car¢ Health Practices for the Elderly" have been issued by HCFA to address problems of prevention such as safe home care. maximialng the heldth care do]Mr, fitDess, relaxallom d~¢t and nt~ititJon, and communicating with one's doctor. Promotion by HCFA of eon~umer/physiclan awareness of the Medicaid Early Periodic Screertirtg Diagrlo~is and Treatment Program (EPSDT) wiil benefit Medicaid eligible children who may not be receiv- ing services to which they are enth[ed. Early Periodic Screening, Diagnosil and Treat- ment Program (EPSDT). Approxlmateiy 2.010.000 eligible Medicaid children were *crcer~f in FY 1980. HCPA will soon publish a new pam- phlet to promote the Early Periodi~ Screening, Diagnosis, and Treatment Program. In addillon. two very successful regional promotional pro- grams were initiated to promote EPSDT and general good health practices for children. Posters, butioos, patches, and media malerlais were developed in conjunction whh those campaigns. 69

Hemoastnltion Project~. Several demonstration projects were funded to provide seIf care educa- tional programs to HCFA beneficiaries. Target populations included AFDC Medicaid mothers and Medicare seniors. A~ these project~ lerminate, the grantees will develop and perform evaluations of their effectiveness. As a result or these eflort~, seniors are becoming increasingly aware of the vflue of self care education. Office of Human Development Service (OHDS) 7O OHDS sponsors social services and human de- velopment programs responding to specific groups with recognized needs. About g0 percent of OHDS funds are dispersed as grants-in aid to States that operate their own programs, such as those for Iow-lncome individuals, families, per- sons with developmental disabitfiies, runaway youths, the elderly, and Native Americans. The goal of the Head Start Bureau of the Administra- tion for Children, Youth, and Families is to bring about a greater degree of special competence in children of low-income families. Head Start health services emphasize prevention, early identi- fication, treatment, and rehabilitative aspects of childhood illness as well as the involvement of the family in an ongoing health care system that will continue after the children leave the Head Start program. OHDS Prevenlion Highlights Immunization Initiative. The Head Start Bureau, ACYF, collaborated with the Public Health Service in attaining the goals of the Na- tional Immunization Initiative. All full-year pro- grams participated in the initiative by providing i~!~rm~iz~tion~ fnr ~ll children enrolled in Head Start. Information about child health and immu- nization services in their communities was high- lighted in education for new parents and provided in Head Start parent and staff meetings and news- Ielters. In addition, the Head Start Bureau deve[- oped a pamphlet. ('Shots and Drops. A Guide for Parents to Immunization." which has been dis- tributed to Head Start parents and the public. Ap- proximately 3d,000 children were reached through this efforl. The services offered were in the areas of outreach, child care. transportation, referral. and direct provision of immunizations in medical- ly underserved areas. Older Amerkans Health Fair Day. In May 1979, Older Americans Health Fair Day was con- ducted in ~t2 states and territories at 415 commu nlty $1tes. Approximately g0,0CO senior citizens participated in health fairs during this project. The equivalent value of $I0 million in community equipment, facilitles, and volunteer services was donated during the 1979 Older Americans Health Fair program. A repeat effort was sponsored in 1980. The health fairs were primarily the result of cooperative efforts by the area agencies on aging and the local American Red Cross Chapters, with oversight and the collection of programmatic and statistical data provided by the National Health Screening Council for Volunteer Organizations, Inc. The Health Fair Model includes health educa- tion, screening tests, counseling and referral, and follow-up of participants found to have signifi- candy abnormal test results. As an outcome of this health fair effort, a guide has been developed for communities interested in organizing health fairs for older Americans, Entitled Older Ameri cans Health Fair Training and Orienlation Guide,

this publieatio~ describe~ the techniques and pro eednrcs for establishing and operating Ilealth ~creeBing at~d foIIo~.up cor~onet~, of hcalI~ ~alrs. Food Programs for the Elderly. The Nutrition Services Program for Older American~, authoriz- ed by Titl~ III(c) of the Older Americans Act~ pro- v]de~ low-cost~ nut£1tio~ally ~ound meals and other nut~itlol~ services+ inc]udin~ o(ltreach ar+d Ilut r~t~on ~du¢~ion. to older persons, par ticldarly ~hos¢ w~th the gc~t~t ~onomic or 5ocial rteed$. Support is authorized for both congregate and home-dellvered meal services. In Fiscal Year 1979. l~ere wePe 1.162 t~utrJtion prog~r~ projects '.g]tb approximately 11 +771 sites located in communities or neighborhoods where meals w~re ~erved. S~xt y- four percent of the mea]~ ".vere served to persotlS below the povei'ty threshold. The average number of meal~ served daily in FY 1979 was 5~7.~65+ Child AbUse and Neglect Programs. Eleven innovative primary prevention ~3roje~ts d~sigt~ed to greve~t child ~bu~ ~d neglect were funded by OHDS in FY 19"79. Three are focusing on parent- infant bonding and perinatal parent support pro- gr~nl~; Iwo are ~,u~reaeh-~ien~ed p~rental Jnfor+ m~tion and ~eferral programs; and the r~malnder ave tl~if~g vari.~u$ approacheg tO l~apeflt ~ucatiorl on child development and coping with family problefns. Because these projects have been in their start-up p~r~od dt~ring the past fiscal year, preliminary findings ~tre not yet available. A col- laborative research project has also been funded to evaluate proeess and iml~aet i~ues related to the prev~r~ion ~roj~x:t$+ 71

Other Federal Agencms Department of Agriculture (USDA) Prevention programs administered by the USDA ]nclude food and nu(rifion programs directed to infants, children, pregnant women. mothers, the elderly, and low-income persons. Perhaps most notable is the Special Supplemental Food Program for Women. Infants and Children (WIC); other programs focus ou nutrition eduea tion. nutrition research, food quality and safety. pollution control and abatement, and environ- mental prolection. Nine agencies within USDA administer these prevention programs. USDA and DHHS convene an interdepartmen tal work group composed of senior officials meet- ing quarterly to improve interaction and program coordination between the two Departments. Joint achievements include an inventory of nutrition education materials, development of an integrated nutrition surveillance and mopitoring system, and Nutrition end Your Heal[h, the dietary guidelines discussed in this volume under Ihe DHHS Nutri- tion Coordinating Committee. USDA P~eventlon Highlights National School Lunch Program: Revised Reg- ulations. In response to current interest in the rela- tionship between heabh problems and consump- tion patterns for sugar, fat. and salt. USDA has revised the regulations for its School Lunch Pro gram to enbance the availability of unflavored fluid low fat milk, skim milk. or buttermilk, as well as foods with lower levels of sugar, salt. and fat. USDA has aJso sponsored a demonstration projecL to study methods of improving the nutri- tion profile of school lunches. NulrfiJon Eduealion Demonstration Projects. USDA awards granls to States to conduct nutri- 72 don education demonstration projects, qthe proj- ects are part of the Nutfltion Education and Training Program. which encourages effective dis- semination of nutrition information to children and provides in-service training to food service and teaching personnel. Mass Media Pilot Project. A USDA Mass Media Pilot Project is currently studying children's attitudes and practices regarding snack- ing. Educational materials will be developed for presentation on television and in schools, grocery stores, and other places in the communlty [re c!uented by children and their parents. Community Services Administration (CSA) The Community Services Administration, suc- ¢es~r to the Office of Economic Opportunity. ad- ministers community action and community eco- nomic development programs designed to help low income families and individuals. Health and prevention-related programs deal with such prob lems as housing, food and nutrition, medical care fur the elderly poor, community food and nutri- tion services that supplement the USDA's larger programs, youth sports programs, and summer recreation for disadvantaged youth. The Corn munity Action Agencies. funded by CSA and other local programs, provide opportunities for organizing health promotion projects at the com- munity level to serve the poor in both rural and ur ban areas. U.S. Consumer Product Safety Commission (CPSC) The Consumer Product Safety Commission is an independent regulatory agency established by Congress in I973 lo reduce the risk of injury, ill- ness, or death resulting from the use of consumer products. The Commission administers five statutes that provide a broad range of legal and other remedies to eliminate hazards related to producls used in the home, at school, or for recreation. TO achieve its goals, the Commission relies on integrating mandatory product standards developed by industry with consumer education. DHHS and CPSC have cooperated on several projects related to accidental injury control in- eluding a study to improve the National Elect runic Injury Surveillance System. CPSC Prevention Highlights Chronic Chemical Hazards. The Commission has been increasing its efforts to control consumer exposure to chemicals that pose chronic heahh hazards, espeeiaHy carcinogens present in con- sumer products. CPSC obtained the voluntary cooperatinn of manufacturers of hair dryers that contain ashestos--a recognized cause of lung cancer--in removing these products from 1he market and in recalling units previously sold to consumers, Child-Resistant Packaging Requirements. Each year. health professionals treat an estimated two mi[Iion children for ingestion of potentially dan- g~rou$ suhstano~'5 The. ¢'Ornmjss[on's rfiOst sign.[- flcant accomplishment in preventing these injuries was issuing regulations that require child resistant packaging for Id categories of hazardous sub- stances includlng prescription drugs. According to

the most reeeni estimate, poisoalngs of children under five years of age have decreased by about 50.000 a year, and the number of deaths by half. as a result of the~c regulations. Children's Toys. In 1980 the Commission issued standards to prevent injury from the sharp points or edges of toys. A second regulation addressed the ~roblem of parts from toys a ~peeial hazard to very young children, who tend to place objects in thelr mouths. Outdoor Meehanlcal Equipment. In 1980 the Commission issued standards for power mower blades that are expected to eliminate g0 percent of blade-related injuries. A second project involves e]ieiting the cooperation of industry to develop a voluntary safe~y standard for chain saws. Department of Education The Department of Education. created as a Cabinet -leval department in 1980, administers and coordinales most Federal assistance for education programs. Projects are supported for develop- ment of school health education curricula, espe- cially for alcohol and drug abuse education. The findings are disseminated to State education agen- cies and local school districts. Office of Comprehensive School Health (OCSH) Health promotion and disease prevention through the education of schoolchildren is a major goal of OCSH. Established in 1979, in the Office of Education's Bureau of School Improvement. OCSH provides advice on school health policy, re- sponds to inquiries from government components and the public, identifies and showcases model school health programs, provides a focal point for school health instruction and services within the Department of Education, and cogaborates with other agencies that have health-related programs. The office has collaborated with the Office of Health Information. Health Promotion. and Physical Fitness and Sports Medicine and the CDC Bureau of Health Education on an evalua lion of the School Health Curriculum Project, the review of applications for the rlth reduction grant program, and the National Conference on Pro- moting Health Through the Schools. Environmental Protection Agency (EPA) One of the Environmental Protection Agency's principal purposes is protection of health. Its ac- tivities in pollution abatement and control, en- forcement of antiponutlon taws and regulations, and research and development in support of standards and control strategies all contribute im- portantly to health protection. Research programs at EPA are designed to identify potential environ- mental problems, examine possible carcinogens in environmental pollutant exposures, and develop exposure-monitoring concepts and techniques. Major program areas are: air quality, water quali- ty (including safe drinking water), pesticides. radiation, sofid waste, toxic substances, and noise. EPA Prevention Highlights Cnrdeulum for Environmental Medicine. The Task Force on Environmental Cancer and Heart and Lung Disease is chaired by EPA personnel. As a resuIt of involvement in the Task Force's Work- ing Group on Education of the Publle and Health Pro fessionals. EPA has initlated several programs to improve the capability of physicians to recognize and treat environmentally-related diseases. The programs include promoting the development of educational curricula for medical students, house staff, and practicing physicians; regional workshops on topics in environmental medicine for physicians; and symposia and printed information on environmental medicine for national meetings of health profe~slonals. Coordination with DHHS. Several measures undertaken in 19g0 by EPA and DHHS are designed to improve interaction between the two agencies, Beyond the formal relationship estah lished through participation in the National To~ icology Program, informal liaison has been established on a number of critical health issues such as toxic waste disposal, radiation, indoor air pollution, and asbestos. An interageney agree- ment is being developed, and the two agencies are cooperating on studies of the health effects of problems at the Love Canal in New York. EPA also supports research through the FDA*s Na- tional Center for Toxicological Research. Federal Trade Commission 0FTC) The FTC is responsible for enforcing the anti- trust laws; for regulating cigarette labeling and ad- vertising; and for protecting consumers from un- fair or deceptive acts or practices in the advertis- ing, packnging~ and labeling of specified con- sumer products. With respect to disease preven- tion and health promotion, the Commission inves dgates two categories of activity: (l) low enforce- ment and rute-making initiatives designed to pre- vent the dissemination of false or deceptive infor- mation about health or health-related consumer 73

product~, and (2) enforcement of antitrust laws whh ~pect to h~llh care in order to ~¢r~l~e ac- cess to itldivldnal health provider~ or organizgd plans that cmpba~ize disease preventiOll and bea]th promotion. The FTC has worked wilb DItHS on a proposed rule regarding advertising directed toward children and in monitoring ciga- retie advertising. FTC Prevention Highlights Proposed Rules for Food and Health Advertis- ing. In 1980, the [:FC proposed a series of rules that would: limit unsubstantiated health pro- motion claims in food advertising; prevent exag- geralion of benefits in the merchandising of hoof- ing aids; prohibit advertising for over-the counter drugs that exceeds the claims approved for pack- age label* by the FDA; and require wartllng~ in ad- vertisements for antacid products, disclosing their sodium content and directing purchasers to read lhe package labels. Orders Preventing the Curtailment of HMOs. To foster the availability of health care providers who cmphaslze early intervention and the preven- tion of serious illness, the FTC has issued orders against organizations that have taken collective action to inhibit the development of health main- tenance organizations in violation of the antltrusl laws, Department of Housing and Ud3an Development (HUD) Prevention-related acllvlties of the Depaxtment of Housing and Urban Development include a~ contributors to health promotion goals and pro- grams', community development block granl pro 74 gram~ for property Itcqulsitlon. construction of public facilities, rehabilitation of buildings, and ~rovision of ~oeial s~rvic~s; environmental plan- ning activities, inri~ding assessment criteria, building codes, and strategies for solving e~virom mental problems~ safely and construction stand- ards for mobile homes; and annual data collection on physical condhfan~ of hollslng units. HUD Prevet~tlolt Highlight~ Al~oholism OnireaCh Program. Alcoholism and alcohol-related problems occur in all segments of the popnlalioyJ, iDeludfag people living in public housing. HUD and the DHHS's National Institute on Alcohol Abuse and Al¢ohollsm have an inter- agency agreement establishing an Alcoholism Out- reach Program. During the past year. NIAAA has conducted a series of workshops to facilitate pro- grams to reduce alcoholism and other alcohol- rdated Problem~ in public housing, and to ~lleviate their effects on family life. Screening, Diagnosis, and Treatment Program. HUD i~ cooperaling with the Health Care Ei~ar~e- ing Administration to improve the delivery of Early and Periodic Screening. Diagnosis. and Treatment Prosram (EPSDT) services for Medieaideligible children living in HUD public housing. Environmental Assessment of Honsiag Slte~ for Ibe Elderly. HUD has developed a guidehe, ok lo assist field scarf in asse~ing the environmental quality Of housing and housing sites for the elderly. Topics covered in the guide range from ISSU~ r~ated to ~if ~iltd ~oise i~o!l~!O~, !hfollgh ¢ommunily fire, police, and emergency health services, Io design feature~ affecting access to the ~ite. DHHS has provided tcchnicci assistance ~n Ihe special health problems of the elderly. Department of the Interior (DOI) As the Federal agency with responsibility for national parks and recreation, the Department of Ih¢ Interior gas ~ub.~lant~l f~e~ial ~o enhance prevention activities. Its Heritag~ Conservation and Recreation Servlce (HCP.S) has participated in many program~ to promole p~y~ical well-bcing and health. Created in 1978, HCP.S administers programs designed to conserve the national herl- tage through preservation of natural resonr¢~ a~ld to erls~lre opportunities for recreation for future generations. DOt Prevention Highlights Exer¢i~ Trails. HCRS has developed mote than 600 exercise trails throughout the United States to provide I~ frf¢, low raain~enartc¢, commurl~ty t~- creation facility that encourages physical well- being. This program was insplred by a belie f in the vital in~erretstionsb~p of rec~at~o~ with mcn/al and physical hcahh. The trails program elicited the Oaoperat[on of the U.S. Jaycee,, the Presi- denl's Council on Phy~ea] Filness and Sports. and benefactors from private industry. Urban Recreation/Health Promotion. HeRs provides grant~ to local governmenls to help physieagy atad ~conomically dlstres~ed urban area~ improve recreation oppo~tunlties for the 70 percent of the populaiion who live in urban areas. Aetfaltle~ m~ty ~neIude rchebilitating ¢xlstlng in- door and outdoor r~creation facilities; demon- strating bmovative ways to enhane~ park and rec- reation opportnnitle~ a¢ the neighborhood levell and developing local resloration programs that identify community needs, nbjectlv~, action pri ~r~tlCs, and s~rateg~ for revitalizing lbe lotal publlc and private recreallon system. HeRS h~ts

i worked with DHHS on ways to encourage health promotion activities through recreation programs and facilities. Department of Labor (DOL) Within tile Department of Labor are the two principal agencies responsible for standard settirlg and enforcement in the area of occupational safe- ty and health: the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Admlni~tration (MSHA). The maodate given to OSHA by the Occupational Safety and Health Act of 1970 is to assure safe and healthftd conditions for workers. The agency attempts to achieve this goal primarily through the establish- ment and enforcement of mandatory standards for working conditlol~s, tools, equipment, facilities, and processes. Enforcement of stand- ards is accomplished through the physical inspec lion of plants and facilities to assure compliance with Federal standards and the ce~ation of oc- cupational safety and health problems. Standards are based on research and recommendations of DIqHS's National Institute for Occupational Safe- ty and Health (NIOSH) and special advisory com- mittee~ and other Federal and State agencies. MSHA was established by the Federal Mine Safety and Health Aft of 1977. Its actlvlti¢~ in elude the development, promulgation, and en forcement of health and safety standards; assistance in mine rescue operations; investiga- tions of serious accidents in mines; recommenda lions to reduce hazards to workers; safety educe lion and tralidng; and technical support for field managers, mlne inspectors, State program employees, and industry management. DOL Prevention Highlights Asbestos Alert -- PhL~e II. OSHA and the Na- tional Cancer Institute (NCI) have jointly spon- sored a second Asbestos Alert Campaign directed to workers as well as their fRmiges who have been direedy or indirectly exposed to asbestos. This na- tional media campaign ~s ~signed In encourage workers to tollow practices that wo,ald reduce their exposure to asbestos, and to investigate workers' attitudes and practices related to occupa- tional safety and health. Another majo~ objeclive of the program is to prepare physicians to respond to inqulries about asbestos-related disease that may arise from this campaign and to examine ex- posed workers with regard to their age, duration of exposure, and smoking behavior. The cam- paign includes regional training workshops and conferences, public serv;¢e announotments on radio and television, and transportation displays. New Directions Grant Program. OSHA has continued to award planning and development grants under its New Direcitons Program to create eduoation and training materials and to provide technical assistance to help control work-related illnesses and to eliminate workplace hazards. Because of its role in promoting the recognition and control of carcinogens in the workplace, the National Cancer Institute has also supported OSHA by funding part of this program. Among the grant recipients are BniOns, trade associations, labor educatlo~ departments of colleges and unlver'sitics, and various nonprofit organizations dedi~d to health promotion among workers. Grantees have created t ralrdng materials and con- dueled workshops and conferences to educate employers and workers in hazard control and health practices, They have produced films, pub[icafions, and slide/sound presentations, as well as conducted research to gather statistics con- coming health and safety conditions. Physician Resid*ncy program. OSHA has cre- ated a physician residency program designed to provide physiciansd n-training with experience and ioslght inlo oceu/mtlonal health problems. Resi- dents from approved occupational medicine train- ing programs spend from one to three months within the agency working directly with OSHA physicians and participating in investigations. Department of Transportation (DOT) DOT assumes an important role in transporta- tion safety and in the environmental impact of transportation. Prevention-related programs are conducted by various DOT agencies: the Coast Guard, for marine environmental protection and boating safety; the Federal Aviation Administra- tion. for safety of civilian aircraft, personnel, pas- sengers and freight, as well as for pollution con- trol; the Federal Highway Administration, for highway safety and motor carrier safety; the Fed- oral Railroad Administration, for motor vehiefe standards, traffic safety, and consumer informa- tion; the Research and Speclal Prugram~ D/rector- ate, for safe transportation of dangerous cargoes; the Transportation Systems Center, for motor, rail, and aircraft safety research; and the Urban Mass Transportation AdmlnJstration, for air pal- lotion control devices for buses and for features that facilitate use by the elderly and the handi- eaot~ed. Of Particular importance is the National Highway Traffic Safety Administration, which promulgates safety standards for motor vehicles, conduct s public consumer information programs, 75

and implements other programs to reduce deaths, injuries, and economic losses resulting from traf- Gc accidents, DOT prevention HighliRhts Child P~ssenger Prate~fion. To prevent the 1,500 deaths and 35,000 hospita[ reported injuries that occur every year in traffic accidents involv- ing children less than five years old. the Nationai Highway Traffic Safety Administration is promot- ing child passenger information and is encourag- ing the implementation of "loan-a-~eat" rental or recycling programs to make these ~;¢ats availalde to Iow-lncome families at a reduced price. To gen- erate the cooperation of Federal and State agen- ties and private organizations, NHTSA convened a National Conference on Child Passenger Protec- tion in December 1979. In addition, DHHS and NHTSA have worked together to incorporate motor vehicle safety into the PHS accident pre- vention strategies and to assist the American Academy of Pediatrics in launching the "First Ride . . Safe Ride" program. Department of the Treasury Law enforcement agencies of the Department of the Treasury contain important prevention activi- ties. The Bureau of Alcohol, Tobacco. and Fire- arms (BATF) regulates the alcohol, tobacco. [egai firearms, and explosives industries. DHFIS works with BATF on issue~ related {o alcohol u~e and elgarclte excise taxes. Department of the Treasury Prevention Highlights Fetal Alcohol Syndrome Campaign. BATF is conducting an information campaign to warn the public in general and women of child-beariog age in particular, that consumption of excessive amounts of afeohol during pregnancy increas¢~ the risk of both physical and mental birth defects. The most severe example is that represented as the Fetal Alcohol Syndrome (FAS). The FA$ cam- paign is e[icifing the cooperation of other Federal and S{ate agencies, the alcoholic beverage indus try, and private health organizations. 76 ...... ~ , 1,m, i

TO produce a more complete picture of preven- tion activities within the Department of Health and Human Services. this chapter presents a eom- prehenslve inventory of the Department's preven- tion programs and projects. In 1977, the first in ventory Of DHHS prevention programs was con- ducted and published as an appendix to Disease Prevention and Health Promotion: Federal Pro- grams and Prospects. This earlier inventory has been reorganized and updated according to 16 eategories--the fifteen prevention priority areas of Hetlltlty People, and another category of cross cutting activities. The inventory includes pro grams of the Puhllc Health Service, the Health Care Financing Administration, and the Office of Human Development Services. Resource levels are reported for Fiscal Year 1979 and Fiscal Year 1980. Several caveats about the inventory are impor- tant to note. In some cases, the amounts provided by Fiscal Year 1980 are estimate* that wRI be revised for the next annual report. Furthermore, each agency applied its own criteria, within general guidelines, identifying its prevention activities. For example, the National Institutes of Health reported only primary prevention research activi- ties, whereas Other agencies may have included secondary prevention efforts. FinMIy. some programs, such as Medicaid, pro- vide preventive heahh services, but current report- ing systems cannot identify the specific sum~ spent for these services. In some cases, an estimate is provided: in others, the sum is excluded. The following list is a key to footnoted items. a. Funded with U.S.-owned foreign currencies obligated in prior years. b. Dollar amount for FY 80 not available. c. Estimate based on proportion of actual visits spent on this activity. d. Flus significant but underdetermined portion of program funds. e. No BMS funds expended. f. Total figure is for all geriatric services, of which smoking cessation is a part. g. Discrete services only. Services for this purpose are also included as a component of several services in a number of states. h. Covers period 6/1/79 through 3/31/g0. i. Covers period 6/1/7g through 5/31/79. 77

|| Agency Table I. FY 1979 and ';Y 1980 Resources For Prevention Act;viUes by Acjencv Department of Health and Human Services 1979 Resources* I980 Resources* PubBc Health ,~rvk-e AIcoho], Drug Abuse. and Mental Health Adrainistration Centers for Disease Control Food and Drug Administration HeaIth Resources Administration HeaIth Services Administration National Institutes of Health Office of the Assistanl Secretary for Health B, ttlt~ Ctttt Fl~|tLg Admi~tt~t~u Of Oee of HemJtn I~velopmeut ~rvkt~ Total Resources $ 26,287,027 $ 26,335,0~I 329,784,500 363.684,965 318,671,000 339,609,000 10,044,821 8,283,507 879,587,946 895,738,0~2 435,171,263 477,12g,940 7,255,856 12,i31,950 148,000,000 173,195,877 816,368.676 1,234,297,587 $ ~,971,171,~19 $ 3,5,,~,404,939 *Reported by individual agencies. 78

Prevention Priority Area 1979 Resources* 1980 Resources" T~b!e 2. FY 1979 ~nd FY 1980 Reso,3roes By ~,~v~ntlon Priority Aro~ D~pmfmo,lt of HeM~h ~nd Human 5~rvJce~ I. Family Planning 2. Pregnancy and Infant Care 3. Immunizations 4. Sexually Transmitted Diseases 5. High Blood Pressure Control 6. Toxic Agent Control 7. Occupational Safety and Health 8. Accident Prevention and Injury Control 9. Fluoridation and Dental Health 10. Surveillance and Control of Infectious Diseases II. Smoking and Health 12. Misuse of Alcohol and Drugs 13. Improved Nutrition 14. Physical Fitness and Exercise 15. Control of Stress and Violent Behavior 16. Cross-Cutting and Other Total Resourcm $ 392.709,279 $ 459.750,567 371,704,910 412,365,637 129.421,938 110,507,594 57,9~8,208 63,027.822 23.915.597 33,556,320 188,662.310 230,682.985 92,963,460 118,349,713 16,983,428 21,g31,654 5,554,g04 I 1385,932 238,267,660 245,082,089 14,137,975 18,095,992 105,057,865 145,28g,367 407,910,692 4g0,070,191 4,181,643 4,521,026 7,538,gl2 6,284,491 914,202,508 1,169,204,549 $2,971,171 ,N9 $3,530,404,9'39 "Reported by individual agencies. 79

~able 3. Prevention Priority Are*6 Department of 14ealth and 1, 2. 3. 4. 5, Family Pregnancy Itnmuniza Sexually High Planning and Infant tlons Transmitted BI~od Care Dise~ Pressure Control Public HEalth .~,rvice Alcohol, I~rug Abuse, and Mental F] ea]tla Admlnlstration $ $ $ _ $ m $ Center for Disease ControI 1,605,~00 1,005,~00 30,288,000 47,479,000 -- Food and Drug Adminlsttation m I 1,200,000 -- Health Resources Administration __ __ m Health Services Administration 225.627,442 338,377,020 47,649,59Z 6,448,422 20,000,0CO National Institutes of Health 29,210,76~ 59,326,080 21.370,002 9,100,400 13,5~6,320 Of flee of the Assistant Secretary for Health 1,350,000 6,651,1~5 -- -- H~llh care Fimmcing Art mintst ration 120.000,0CO -- -- -- office of Human Development ~ices 81,956,360 7,C06,382 -- -- Tolal Resomces Rep?rted $459,750,~,67 5412,365,637 $110,507,594 ~3,027,1~22 $33,556,320 80

6, 7 ~. 9, 10, 11. 12. Toxic OccupaLiollal Accldent Fluorldat ~on Surv~l[an~ Smoking Mis~lse of Agent Sa~tv P~velLllc~n a~d D~nIa[ and Control and HealIh Alcohol Control and Hca]Ih and Injury H~llh of Inf~tlous a~d Drugs Control Disca~s 13. 14. 15. 16. Improved Physical Control of Cross- Nutrlt~on Filn¢~ Str¢~ and culting Exercise Violent and Olhcr Behavior Total 4,510,0~) 85,~77,000 50,000 140,245.985 $230,682,985 $ 79,407,000 I42,748 17,IC~,O00 21.699,965 $ -- $ $ -- $ -- $ 14,507.322 $ -- $ -- $ 1,197,840 $10,629,889 $ 26,335,051 11,784,099 6,773,000 61,255,9155 4,J~OO,000 3,EO3.000 m 111,577,000 363,694,965 709,009 15.874,~0 -- 69,38~,~0 51,637,000 104,724.000 339,609,4!~00 -- -- 54,971 m m 1,9~5,C99 m 6,119,699 8,283,507 4,[~7,~0 m 155,208,809 457,373 14,445,000 11,892,364 -- 54,344,639 89ff,738,032 5,000,090 5,012,932 12,688,353 11,164,924 1,251,545 25,834,702 3,921.036 4,495,75g 113,250,173 477,128,940 2f)l,27a m 2,073,695 50,719 ~,0~ 194,696 1,010,4AI 12,131,980 ...... 53,195.877 173,195,~'77 .... 45,645,781 385,140,026 396,197 714,152,841 1,234,29"/,~7 $118,349,713 $ 21,831,654 5 11,785,932 $24S,0~2,089 $ 1g,095,992 $145,2~,367 $480,0711.191 $ 4,521,n36 $ 6,284,491 $1.169,204,.¢,49 $3,530,404,939 81

Table 4 FY 1979 and ry !980 r,eve,~tio,~ Invenlories

m Public Health Service Centerfor Disease Control Food and Drug Administration Health Services Administration 1. Family Planning 1979TotalS392709.279 1990 TOt~+$:lFQ759~B7 Bureau of Epidemio[n,~v Abortion Surveillance and Epidemiologie investigation of Risk Contraceptive-Related Surveillance and Epidcmiologicai Research Bureau of He~dlh Education PTA (parenting) Project Sex Education Study--Programs for Youth Aged 10-19 Years Bureau of Biologics Study in Egypt of Correlations of Human Semen Parameters with Fertility and Assessment of Risks Associated with Microbial Comaminants of Semen (with The Office of lnlernationa[ Health, OASH) Bureau of Community Health Services Family Planning Community Health Centers Migrant Heahh Maternal and Child Health/Crippled Children National Health Service Corps Bureau of Medical Services Family Planning Services Family Planning Research ]979 Resources $ 297,900 1,296,600 305,000 1.720.000 135,0C0,0C0 23,500,000 2,4C0,0CO 25,000,0~) 4,300,000 36,800 44,800 1980 ~ ~ Resources ~ ~ ~ t~ $ 231,000 • • 1,007,000 • • 368,000 • 162,000.000 • 28,770,000 • 2,760,000 • 25,000,0tD • 5,060,000 • 141,942c • I • ! b 83

National Institutes of Health Office of the Assistant Secretary for Health 84 I r. m;ly Plannlno Contraceplive Use and Family Planning Indiln HeRllh ServJ~e Ciinicai Services and Preventive HeaIth Divislon of Research Resolrces Family Planning Research Nllio.al I.stilute of Chgd Health and Humln Devaiopmenl SoclaI and Behavioral Research Human InfertiLity ConJraceptive Development Contraceptive Evaluation Office of Population Affairs The overall planning, oversight, coordination, monitoring, and evaluation of the family planning service programs administered by the Health Services Administration, the Health Care Financing Administration, the Office of Human Development Services. and the Ofl~ce of Adolescent Pregnancy Programs The overall planning, oversight, coordination, monitoring, and evaluation of the population and f3mJIy p]atlnJl~g research programs administered by the Health Services Administration, the Natiottat Center for Health Statistics, th~ National [nstilutes of Health, the Center for Disease Control, and Ihe Food and Drug Administration 1979 Resource5 $ 3.503 1,856,933 5,875 10.176,000 1,749,0(KI 7,169,@ 5,424,000 220,000 130,000 1980 Resources $ 3.5130 1.892.000 6,765 1 l,~k~O,O00 1,796,000 g256,000 7,g72,000 220,000 130,000 "H 'gd 0

Health Care Financing Administration Office of Human Development Services c. =mnily PIsnning Office of Health Research, Stali~tics, and Technolog.v/Natioaal Center for Health Slalislics National Survey of Family Growth Rnreau ¢0f Program Operations Medicaid Support for Family Planning Administration for Children, ¥oe~h, and Families Head ~t~trt/P~.r~.t E~*J.cat~ott Pr~g~e.r~ ~t~d Parent-Child Center Office of Prol~ram Coordination attd Review Family Planning Services, Education (Title XX) I979 1980 Resources Resources ¢.~ $ 800.000 $ 1,000.000 99,000,030 120,000.000 • 200,000 • 72.073,871 81,956,360 • 85

2. Pregnancy and Infant Care ~980 TotaT $412.365,637 Public Health Service Center for Disease Control Health Resources Administration Health Services Administration Bureau of Epidemiotovj Epidemiological Research on Birth Dcfccts Bureau of Laboratorie~ Laboratory Applied Research Bure~m off Hemlth Professions Publication "Child Health Assessmcnt Study" Maternal Child Health Continuing Education for Nurses--University of Washington Bureae o[ Community Heallb Services Sudden Infant Death Syndrome (SIDS) Program Community Health Centers Migrant Health Maternal and Child Health/Crippled Children National Health Service Corps Health Awareness (SIDS, Sickle Cell, Hemophilia) Screening, Identification, and Services for Blood Disorder/Genetics Program Screening, Identification, and Services for Metabolic Disorders/Maternal and Child Heahh Screening, ld~nti~cat[on, a~d Services for Chromosomal Abnormal];]es and General Genctlc Diseases/Materna! and Child Health/Genelics Program 1979 ~gource~ $ 330,000 $ 7.575 165,000 2,802,000 117,575,000 13,650,000 112,350,0(;0 27,575,000 3,1C0,000 6,575.0~) 1,900,000 5,900.000 1980 Res(3u r Ces 667,000 338,000 • 2,802,000 • 144,040,~00 • 15,710,000 • 112,350,000 • 32,400.000 • 3.100.000 • 6,575.000 • i ,9oo,ooo • 9.900.000 • 86

2. Pregnancy and Infant Care Bureau of Medical Services Program to Keep Children Healthy and Promote Early Diagnosis of Child Health Problems Sexuality: Coun~ellng on Prenatal and Postpar(um Care (with IHS) Indian ~lezlth Service Clinical Services and Preventive Health Office of Interandonal Health Affairs Study in Egypt of the Detection and Treatment of Inborn Errors of Metabolism which Impair Mental Development (with the Office of International Health. OASH) Study in Egypt of Perinatal Sereen~ng of Developmental Malformations Study of Lactose Intolerance in Egypt (wlth the Office of International Health, OASH) Neonatal Care Study in Egypt (with the Office of International Health, OASFI) Study o[ the Effectiveness of Genetic Counseling ~n Poland (with the Office of International Health, OASH) S~udy la Poland of the Cost-Benefit. Medical ,~nd $~i~]oglc~ A~pects of p~n~! D~nc,~i~ (with the Or'lice of International Health, OASH) Study in Yugoslavia of Low Birth Weight and Maturity in Child Development (with 1he Office of lntcrnndonal Health, OASH) 1979 1980 Resources Resources $ 1.819.820 S 2,100,020 • 29,8(;0 b • 7,390,603 7,500,000 • a a a a a a a a a a .o I el •1 ol •1 el 87

National Institutes of Health Office of the Assistant Secretary for Health 2. Pregnancy and Infant Care 9ivi~ion of Research Resources Pregnancy and Infant Care Research National fnstitele of Child Health and Human Deve[opnlent Mental Retardation Sudden Infant Death Syndrome EpidcmJology and Biometry Social Learning Nutrition High Risk Pregnancy Fetal Pathology Prematurity Disorders of the Newborn Congenital Malformations Study of Genetic Anomalies in Egypt (with the Office of International Health, OASH) Office of Adolescent Pregnancy programs Community-based Adolescent pregnancy Programs Offke o[ Health Research, Statistics, and TechnologY/Nadon~l Center for Health Services Research A Comparative Study of the Implementation of Child Health Pollcw 1979 ReSOUTCeS $ 2,438,958 16.122,0~ 4,912.000 636,600 1,924.C~0 9,624,000 8,315,000 6,3~,000 3~4i5,000 4.750,000 6,102,C~0 740,0~ 26,843 1980 Resources ~,~ $ 2,811.080 • 15.192,000 2,704,000 696.~0 1,803,000 9,526.000 8,646,0@3 5.626,000 3,040,000 4,337,000 4,945,000 6,450,0(20 • 2,419 .I

Office of Human Development Services Pregnancy and Infant 1979 1980 Resources Resources Obstetrical Practice and Perinatal Outcome $ 43,920 $ Impact of EPSDT on Health Services Utilization 19,616 -- Decifion and Policy Analysis for Fetal Monitoring 28,366 2,841 A Study in Policy Activation: The Case of EPSDT 29,221 -- Evaluation of an Alternative Birthing Center 128,388 128,560 Impact Evaluation of Programs for Mothers and Infants -- 30,947 Priorities for Research in MCH Services: A Literature Review -- 36.388 Administration for Children, Youth, and Families Head Start/Parent Education Program and Parent-Child Centers -- 260,000 Office of Program Coordination and Review Services to Expectant Parents (Title XX) 4,919,800 6,746,382 Day Care, Information and Referral (Title XX) d d Program to Keep Children Healthy and Promote Early Diagnosis of Child Health Problems (Title IV-B) d d g

Public Health Service Center for Disease Control Food and Drug Administration Health Services Administration 90 3. Immunizations 1979 To!al $129.zt21.938 1980 Total $1 ~0.507.594 Bureau of Health Education Survey and Analysis of immunization Attitudes and Behaviors Bureau of State Services Immunization Program: Publlc Information and Education as Part of All Grant-Support Projects Immunization Grant Program Dissemination of Information About Immunization Services Immunization Service Delivery Research Bureau of Biologies Vaccine Testing Bureau of Community Health Services Community Health Centers Migrant Health Maternal and Child Health/Crippled Children National Health Service Corps Bureau of Medical Services Program to Reduce the Incidence of Communicable Disease/Diseases Preventable by ] m munlz~ation Indian Health Sei'Tice ClinicaI Services and Preventive Health I979 1980 Resources ~csource$ $ 60,300 $ 2.~O0,G00 36,000,000 400,000 575,000 I0,560,000 3,450,000 575,000 32,700,000 1,250,000 1,330,670 7,292,164 4,087.(X~ • 24,532,(X~ • 690,0~0 • 979,030 I 1,200,000 4,230,000 • 660,0C~ • 32,700,000 • 1.470,0G0 • g ~ g ~ ~ ~

National Institutes of Health Office of the Assistant Secretary for Health Health Care Financing Administration Office of Human Development Services .% Immunizations Division o[ Re~earch Resonr~ I mmtJnizations Research National Cancer Inslilute Suppression of Tumorigenesis by Immunization National In~titule of Alle~y and Infectious l)i~a~e$ Program to Reduce the Incidence of Communicable Disease/Diseases Preventable by Immunization (excluding sexually transmitted diseases) Office o1' Health Rey~arch. staastiex, and Technology/Natlonal Center for Helllh Services Research Estimating the Costs of Se]ected Medical Events Related to Administration of Specified Vaccines Ol'fiee of Spcclal Progrums/Office of Child Health Immunization Services Administration for Children, Youth and Families Head Start/Immunization Services 1979 Resource~ $ 181,362 2,707,000 18,000,442 d 12,003,000 1980 Resources $ 209.011 2,160,000 19.000,991 d 91

4. Sexually Transmitted Diseases ~979 Tot~ ss:gss.2oB 1980 Total $63.027,822 Public Health Service Center for Disease Control Health Services Administration National Institutes of Health 1979 I~0 acsourqes Resources eereau of State Services VO Program: Educatlon in All Grant-Supported Projects ~n Sexually Transmileed Diseases $ 7,900,000 $ 6.133,000 • Sexually Transmitted Diseases Grant Pro~am 3~,900,0~ 40.00:),000 • [n~rm~on D~ssemi~adon on Sexually Transmltted Diseases Grant Prog~m [85,~0 149,000 • SexuaLly Tran~mitt~ Disease~/Cllnlca[ and Service Delivery Research 1,600,000 1,197,000 Bnr~Bu of Medical Services ~e~earch at Seattle USPH$ Hospital (~2,912 4],600 Indian Heallh Service C]inlcal Services 6,089,912 6,d06,822 • N~tlonal Can~er [n~litute Development of Tes~ for Herpes Virus 600,000 1 ,~0,~0 National lns~i(ute of Afiergy =rid Infectious Diseases Research and Vaccine Develol~mcnt ~.000,384 8,0C0,400 ~/~ 92

Public Health Service Health Services Administration National Institutes of Health 5. High Blood Pressure Control 1979 Total $23,915 597 1980 Total $33.556320 Bureau of Community Health Seiwiet~ Hypertension Grant Program Sureao of Medical Serv~et.~ Cooperative Study--San Francisco Public Health Hospital and Johns Hopkins University Cooperative Hyperterlsion Study with Baltimore Hospital and Johns Hopkins University Division of Research Resources High Blood Pressure Control Research NatioNal Heart, Lung, trod Blood lnslitute National High Blood Pressure Education Program--Support Ad Council/Mass Media Statewlde Demonstration Projects HeaRh Education Message Testing Health Hazard Appraisal Regimen Compliance Hyper t cnsion Control--Wor kset fag Rural Mining Community Hypertension Control Direct Operations and Program Management National High Blood Pressure Education Research Programs--Psychological BP Control Modalities; Regimen Adherence; Stress Reduction 1979 1980 ~esoHrces Resources ~,~ $ I1.000,000 $ 20,0~0,000 • e e • ee • 338,597 390,195 2,078.000 2.196.548 • 343,(~O -- • 4,258,000 4,020,547 • 66,000 66,000 • 132,000 132,000 a 68,000 -- • 520,0OO 539,704 48.000 -- • 852,000 1,0oo,000 • ! ,2 ! 2,~tY30 !,780,-000- C~ 93

l r National institutes of Health 5. High Blood Pressure Control ~coo~.~o~, National Hea£l, Lung, and Blood Institzlte (~ontinued) Hypertension ]Detc'ction and Follow-up Program (NHLBI--Nationa[ ClirLical Trim Component)-- Scrcenlng of Populatiorl a~d VolZow-up Scr¢crzitig c~" H~h-RJ~k Popz~]atiOrl; RcfcrTa] lo Trial or to Treatment; Coun~elizlg for ~iblings arid Spouses. 1979 19g0 $ 3,000,000 $ 3,431,326

6. Toxic Agent Control 1979 rolal 9199.ooz3 o 1980 TOt~T $230,~82,885 Public Health Service Center for Disease Control Food and Drug Administration 1979 ae~@~F¢cg Bureau of Epidemiolcvgy Chronic Disease Investigation $ 250,000 $ Bureau of Laboratories ~nd Bureau of Epideralolo~ty Toxic Emergency R¢~ponse/Asslstanc¢ to Slates 1,347,800 attreaa el" Stale Services E nvlronmt:nt al Hazard~ 376,200 Bureau of Foods Food Additives 15,987,000 Chemical Contaminants 12,249,000 My¢otoxlns and Other Natural Poisons 3,874,000 Food Service, She]irish, and Milk Safety2,416,000 Cosmetics 2,044,000 Sludy in Egypt of Poisonou~ Plants Contaminating Edible Ones and Toxic Substances in Plant Foods (with the Office of International I-lea]th, OASH)a Study in Poland of Nine Teratological GRAS Sub~tance~ (with the Office of International HeaIth, OASH) a Tunisian Mycotoxin Survey of Tunisian Foods (with Ihe Office of International Health. OASH) a Bureau of Radiologieal Irlettllh Ionizit~g Radlation--Products and Devices 7,537.000 ionizing Radiation--Use Control 5,786.000 1988 ~ ~ 1,591.000 • • 1,355,030 • 1,5(ul,O00 • • 16,901,000 • • 13,506,000 • • 4,113,000 • • 5,779,000 • 1,885,C'00 • • a a • a • 6,230,1K10 95

Health Services Administration National Institutes of Health R.. Toxic Agent Contro ,¢o. ,,~ Light Radiation Sonic Radiation Radio Frequency Microwave N~tlolud Ceuter for Toxicolo#cal Research Programs to Study the Biologlc'at Effects of Potentially Toxic Chemical Substances Found in Man'~ Environment 14,175,000 21,000,000 Bureau of CQmmunity Htlllh Service; Migrant Program: Pesticide Poisoning Prevention 50,000 50,000 Bureau of Medical Service~ Emergency Medical servlces/Poison Prevention Centers 600,000 -- Study in India of Role of Arthropods in Transmission of Leprosy (with the Office of International Health, OASH) a a Indian Health Servite Study of Epidemiology, National History and Control of Trachoma in Tunisia (with the Of~ce of International Health, OASH) a ~ Di,ri~ion of Resettreh Resound; Toxic Agent Cuntrui Research ! ,623,310 1.870.985 National Cancer Ia~tltute Nalional Organ Site Program 7,062,000 7,156,000 1979 1980 Resources Resources $ 3,815,0130 $ 4,181,000 • 1,272,000 1,393,000 • 2,618,000 2.805,000 • *1 .I •L .I

-- I 6. Toxic Agent Control The Carcit~ogenesis Research Program ToxicoIogic Testing Program Development of Improved Tests to Predict Carcinogenicity Coordination and Support to Other Federal Agencies NaIional Heart, Lung, and Blood I.stitute Fibrotic and Immunologic Lung Diseases; SCOR Programs on Hypersensitivity Pneumonitis and Pulmonary Fibrosis National Institule of Environmental Health Sciences Environmental Health Research and Manpower Development Resources Prediction, Detection, and Assessment of Environmentally Caused Diseases and Disorders Mechanisms of Environmental Diseases and Disorders I979 1980 ~ ~ r .,~ Resources Resources ~ ,t~ ~ $ 29,359,000 $ 32,968.000 • 21,308,000 39,185,000 • 4.504.000 5.438.000 • 2,489,000 4.816.000 • 3,016,000 3,058,000 • 8,047,000 8,169,003 • 22,311,000 22,667,(~00 • 14.546.000 14,918.000 • 97

7_ OccupatJorlal Safety and Health m~ 1o~ s .~2.9~3.~0 Public Health Service Center for Disease Control 98 I979 ~eSOU~C~ 1980 Resources National lustitute for Oeeupatlonzl Safety and Hearth Program Support $ 3,(;00.000 $ 4,300,000 Manpower Development and Training I 1,400,000 14,100,000 Quality Control and Records Management 4,100.000 5,000,00~ Monitoring and Methods I3evelopment I~esearch 6,200,000 7,000,000 Toxicology and Laboratory Research 7,200,000 8,iX;O,000 Epidemiological P, escar c h-- Surveilla nee and Field Studies 10,400,000 11.607,000 Behavioral Research 943,090 1,000,000 Criteria Documentation and Standard~ Development 10,3CO~000 I0,000,000 Health Hazard Eva/uaclon~ 2,7G0,000 6,000,000 Toxic Subslances List Technical Inforrrmtion and Assistance 2,850,0CO 3,000,000 Safety Research 3,800,000 4,3(;0,000 Other 5,100,0CO Evaluative Studies in Egypt of Exposure to Cement and Flour Dust (with the Office of International Health, OASH) a a Studies in India o1" Infective PneumoeonIosis and pncumocooiOs'~ due to MJ¢.~ Dust la~alat~oz~ (with the Office of International Health, OASH) a a Studles in Poland of Severtd Problem~ Including Chest Diseases in Coal Miners; Effects or" Acute and Chronic Vibration on Health of Workers; Effects of No~se and Heat on the Heatlh of Worker~ in the Metal Industry a a g'~ • • • • • s Q

Health Resources Administration Health Services Administration National Institutes of Health 7. Occupational Safety and Health 1979 R~t,OuTCC~ Bureau of Heallh Prof~sion~ Grants for Preparation of Occupational Health Nurse Practitloners $ 141.592 Development (with NIOSH) of CurrlctJlum Content and Ptactlce [ncludln8 Envlronmonta[ ]Factors. Accident Prevention. and Health Screelling in the Occupational Setting d lluregu of Medicml Seevlce~ Occupational Health Training Programs (Division of Federal EmploYees Occupational Health (DFEOH)I I00.000 Workers' Occupational Health Education On Federal FacJllties (DFEOH) 1.500.000 Division of Fodcral Employee Health Preventive Healt}1 Screen}n8 IProgram~ (0.8., hcarln8 tests. vision tests) 3.800.000 Emp[oycc Health Units 10.000.030 Employee Iqca[t/1 Malntcnancc. Exams. and Special Job-Related Exams Division of Re,each Resources Occupational Safety and 14ea]th Research N~llon~l Cancer In~tltule Educ~tior~a] Progr~m~ to .P.ed~-'e Work-Re!~ted Cancer's Program to Reduce Asbestos Exposure 2.000.000 26.868 3,826,~000 1.600,000 1980 Re~ourc~ $ 142,748 d I00,000 [ ,500,000 3,500,000 ]0.000.000 2,000.000 30,%5 H,892,~CY30~ 1,000,000 g

Office of the Assistant Secretary for Health 10o 7. Occupational Safety and Health Program to Reduce Radiation Exposure Studi~s to Evaluate Cancer Risk Among Workers Nallonal Hetlrt, Ltlng, and Blood In~|itut¢ Immune and Fibroti¢ Responses to O¢cupatlortal Environment Office of INscase Preven¢ion ~ Heallh Promotion/Office of Health Information, Ht'alih Promotion, and Physical Fitness and Sports Medicine National Colafererlc¢ on Health Promolion Programs in Occupational Settings Obtaining from the President's Council on Wage and Price Stability Exdmption of Employee Health Promotion Programs From the 7 Percent Wage Guidelines Cosponsorship with Washington Business Group on Health Meetings with Industries to Foster Introduction and/or Strengtheldng ot" Evaluation in Employee Hea~th Promot}on Programs Evaluation of a Federal Occupationally B~sed Health Promotion Program Development of Guidelines for Health Education and Health Promotion Programs in Occupational Settings Development of a Set of Common Data Items for Comparative Evaluation or Workslte Health Promotion Programs 1979 1980 $ 1,569,000 $ 1,602,0tY3 • 5,696,(x)0 6,500,000 664,000 675.0~0 47.000 -- • r [

Public Health Service Center for Disease Control Food and Drug Administration Health Services Administration National Institutes of Health Office of the Assistant Secretary for Health Accident Prevention and Injury Control I979 1980 RC$OtlTCe~ Re~olJrc~s Bureau or state Services Lead Sascd Paint Grant Program $ 7,475,000 $ I].250,000 Lead Poisoning Prevention: Education on Lead Hazards in All Grantee Project~ 1,025~0(X) 534.000 Bor~mu of Drugs Poison ControI 729,0(:0 709,000 Bureau (if Commurlily Itmlllh Servict~ Materna~ and Child Hcahh/Aecident Prevention Projects 675,0~) 675,0~1 Indlan Health Services Clinical Services and Preventive Health 3,275,363 3,462.380 National Heart, Lung~ ~md Blood Instilate Rchabilltation and Corrective Surgery Rcsearch/ Cardiovascular and Other Circu]atory Trauma 3,600,0(~ 5,000,000 Office of lleltlth Rt~tnlrch, Slatislics, and T¢chnolokny/N~ltion21 Center for Health Servit'e~ Research Quandtadon of Injury and Critical Illness 89,788 49,826 EMS Severity Index Research -- ]2,128 ~everity Index Conference -- 35.000 Severity Index Construction: Methods, EMS Applications II4,277 104,320 1979 Total $16.983.428 1980 TOIpI $21.831.654 e ~p "1 ol el ol 101

9. Fruoridation and Dental Health ~979 :o,~, s ~.~s~8o~ 1980 To~;,f $11.785.932 Public Health Service Center for Oisease Control National Institutes of Health eurean of State Setviee~ Fluoridation Program Technical Assistance Division Of Researe}t Re~ouree~ Fluoridation Research Natioltal Instltule o1" Denial Rer.¢atreh Caries Prevetltion Pcrlodontal Disease Preverltion Cross-Cutting and Other 1979 19~0 R~ourc¢~ $ l,CO0,O00 $ 5.000,000 1,771,000 50,786 58,512 2,583,903 2,842,293 840,640 924,704 1,079,475 1.187,423 102

10. Surveillance and Control ~79 To,.~, S2;8.~z.b60 of Infectious Diseases 1980 To,~, S2.~.082.089 Public Health Service Center for Disease Control Food and Drug Administration Health Resources Administration Bureau of Epidemiolo~v, Bure'~u of L2boratories, Bureau td" ~late Services Disease Invcstlgatlon, Surveillance, and Control aureem of Laboralories Cooperation with India oll Ev~uation of Scrologic Tests for the Epldcmio]ogy or" Malaria (with the Office of International Health, OASH) Laboratory Improv~'rncnt WHO Improvement of Laboratories aureaa or State Servlce~ Infectious Diseases/Servlc'e Delivery [niec(ious Disca~¢~/Informatlon Dissemination Office of lnleraltional S~'~iee~ Studies in Egypl Directed Toward Prevention and Control of Hepatitis, Including Post Transfusion Viral Hepatitis (with the Office of International Health, OASH) Bureau ut" Biolo~ic~ Blood and Blood Products Viral and Rickettsial Products Racterlal and Allergcnic Product~ Bureau cJf Heallh Professions Program to Prepare Epidemiologica] Nurses to Work in Area of Infectious Disease Contro] izl Acute Care Seltings--W~tync State University 1979 1980 Resources Resources $ 34,282,900 $ 35,660,000 a a 9,925,000 10,100.000 254,100 95,%5 12,200,000 13,100,000 2,000.0~ 2,300,000 d d 6,272,000 6,702,000 5.070.000 5,399,000 3,531,0~0 3,773,000 87,631 54,971 ~ e s~ • 103

Health Services Administration National Institutes of Health 104 10. Surveillance and Control of Infectious Diseases -- - . Bureau of Community Health Scrvtcts Migrant Program: Sanitation Bureau of Medical Services Research Projects on Infectious Diseases Being Conducted at U.S. Public Health Hospital at San Francisco (iacludlng leprosy rc~¢arch) Indian Health Service Pre'centive Health and Clinlcal Services Division of R~earch Resources Infectious Agent Control Fogarty International Center Studies on Victors and Agents of Infectious Diseases PreValent in the Tropics National Cancer InsUtttte Biological Carcinogenesis National Eye Institute Study in Egypt of Ecology of Trachoma and Other Eye Infections (with the Office or International He*~!th, OAS14) National Inslilule of Allergy and Infectiolls Dgl~ase~ Prevention of Vector Transmitted Diseases 1979 Resources $ 500.000 ~30,843 153,256,793 61,826 1,700,0~0 3,873,0O0 d 4,000.567 1980 ~ ~' Resources c~ ~, ~ t~' $ 500,0(~ • • 208,800 • 154,500,000 • 71,205 • 1,0O0,0C~ • i 5,507,000 • 5,000.148 •

10. Surveillance and Control of Infectious Diseases (Confinued) Studies of Epidemiology of Meningitis due to H. Influenzae and Other Bacteria in EgYpt (with the Office of International Health, OASH) Studies of Bionomics of Anopheline Vectors of Malaria in Egypt (with the Of Bce of International Health, OASH) Studies in Egypt Concerned With Various Aspects of Schistosomiasis (with the Office of International Health, OASH) Studies in Egypt of Tick vectors of Disease Agents and Epldemlological Studies of Tiekhorne Infections (with the Office of International Health, OASH) 1979 Resources d d d 1980 Resources d d d 2 I Q lOS

11. Smoking and Health 979 total 14. gT,97s 1980 Tot~T 51~ 095,99~ Public Health Serviae Alcohol, Drug Abuse, and Mental Health Administration Centerfor Disease Control Health Services Administration National Institutes of Health 106 National lnstilute of Drug Ahuse Long-Term Maintenance in Smoking Cessatloa The Rolt" of Nicotlrle and Other Reinforcers in Smoking Developing a Safer Cigarette Bureau of Health Education National Interageney Cour~c}l on Teen~gc Smoking Project Smoking and Health Education for Youth Naliont~J ln~titwte for Oeeup~llon~l S~fety and Heallh Smoking and Health Studies Bureau of NI~/Cal Services Geriatric Services Patient Educatloa--Divislon of Hospitals and Clinics and Federal Employee Health Division of Research ResourcL~ Smoking Cessation Research National Cancer Institute Smoking Education and Information Identification of Harmful Constituents in Tobacco Smoke Epidemiology to Assess Smoking Risks 1979 1980 Resource, ~c,nurces $ 64,337 $ -- 66,572 22,565 26,000 161,300 3,600,000 -- 800,003 40,977 121,373f • 336,000 336.000c • 12,983 14,924 1.700.~10 3.880.000 • 2,123.000 1,250,000 2,039,0(Xl 3,150,000 e s~ -I

Office of the Assistant Secretary for Health ! 1 Smoking and Health National Heart. Lung, and Blood In~tRule Stanford--Smoklng Prevention Eduea6on and Smoking Cessation Programs on Individual and Groklp Levels National Research and Demonstration Cenler. Baylor College of Medicine--Adult and Adolescent Smoking Cessation and Prevention Programs (Social-Psychological Deterrents in School Project) National Research and Demonstration Center, Vermont Lung Center--Smoking Cessation in Schools (School Health Education Project) identification of Variables Associated with Maintenance of Nonsmoking in Ex-Smokers National Institute of Child Heallh and Human Development Maternal Smoking and Effects on Fetal Development Prevention of Smoking in Childhood Office of Health Research, Statistics, and Teehnolol~y/ National Center for Health Services Research Yhe Benefits and Costs of Anti-Smoklng Policies The Potential for Using Taxes to Reduce Smoking Medical Costs of Cigarette Smoking 1979 1980 Resourecs Resourcc~ $ 700.000 $ 750.000 1 .g(X).000 1.800.000 50,000 -- 350.000 942.424 2.199.720 46,690 31.866 28.987 23.381 ~ ee 0 0 A 107

1. Smoking and Heaffh Office on Smoking and Health Ptallnlng Conforen¢¢ on Smoking and Heallh in Minority Communities National Poster and Essay Conte~t InvoIvlng 7th Grade Students Oe~¢foflment of` ~ Natiorml Ittf`orr~atfon artd Education Program Technic~.l Information Services--lnqulry and Reference, Pholocopy, Computer Search ~nd Retrieval Services--and Production and Dislributlon of Publications 1979 Smoking and lfeahh: A Report of the Surgeon General 1980 The Health Consequences of Smoking/or Women: A Report of the Surgeon General Study to Evaluate the Re]ative Risks Associated with VaryiNg Levels of Tar, Nicotine, and Carbon Monoxide in Cigarettes Survey of'Adult Smoking Rates Data Collected for OSH and Report(s) Written by National Center for Health Statisdes Projects in New Jersey to Dealonstrat¢, at the Slale Level, the Feasibility of Developing a Comprehensive Antismoking Program in High-Risk Communities 1979 1980 Rcsoll Fcc~ ]~eso/irces /// 75,000 $ -- • 42,000 37,000 • 370,0~0 432,280 • 545,000 820,732 • 250,0~ • 150,000 • 25,000 125,000 • 300,000 395,961 • 99.O00 F • 108

Public Health Service Alcohol, Drug Abuse, and Mental Health Administration Misuse of Alcohol and Drugs 1979 Resourcc~ National Institute of Alcohol AhuP, e and Alcoholism Techniques to Reduce Alcohol-Related Accidents $ 250,000 ABC Laws 88,009 Basic Principles 261,0(30 Alcoho[ as a Community Response 74,631 Community Cuhure--A Means of Prevention 105,627 Community AlcohoI Abuse Prevention Strategies 130,658 Alcohol Prevention in Small Rural Communities 107,887 Alcohol Education Curriculum Project ] 16,655 Alcohol, Mass Media, and Public Education 126,699 Replication Training 24,413 Field Representatives Training in Prevention 174,239 University Demonstrations for Students/Parents 143,g40 Supermarket Publications 62,400 Alcohol Outlets, Drinking Patterns, and Local Zoning Impact of Approaches to Primary Alcohol Prevention Prevention, Treatment, and Rehabilitation Program Youth and Alcohol Prevention Teen Alcohol Prevention Prevention Model Reolication Evaluation of Model Alcohol Education Project Services for Children Symposium 87,106 m 51,216 215,136 400,000 132,393 26,969 1979 T~Ip' $!95~578G5 I980 Resources ~2 $ 135,000 88,000 142,000 168,602 • II6,851 • I38.365 • 56,543 • 140,485 • -- @ 67,2t~) • 213,820 • lg,215 • 98,329 • 387,030 • 199,912 • 3,476 • a

iIO 92. Misuse of Alcohol and Drugs I979 ~egOtll~S Prevention of Alcohol Problems in Predelinquent Youth $ 121.481 $ 21.399 • Minimizing Alcohol Problems by Focus on Youth 16I ,451 25,624 • Westchesler County Student Assistance Program -- 111,056 • Children ef A~coholic Parcmts IntervonIion Strategies -- 134,176 • Raising the LegaI Drinking Age ]n Michigan and Maine -- 122,502 • A~essing the Impact of Legislation Raising Massachusetts Drinking Age -- 347,235 • Alcohol Abuse Education Facilitle~ for Elderly 78,604 • Fetal Alcohol Syndrome Prevention177.819 141,605 • Identification of National Center for Health Statistics Data Sources for Information Pertaining to Alcohol Consumption 125,000 135,000 • Primary Prevention of Alcohol Abuse Among Women -- 229,466 • Mayors' Leadership Institute -- 50,386 • Public Education Campaign -- 1,246.545 • Public Education Campaign Evaluation -- 548,849 • California Indian Youth Alcohol Education 175,251 189.241 • Native American Peer Alcohol Abuse Prevention 52,510 15,000 • Prevent~or~ Programs for RCdHCing Exeess]v.~ Drinking in Spanish-Speaking Communities 27,51~ Clearinghouse: Primary Prevention Activitie~ 674,0~ 674dXFO • ]~ ~-qgalvee~ (t7

Misuse of Alcohol and National lnstitule of Drug Abuse Impact Study: State Drug Usage Evaluation National Prevention Evaluatlon P.esourc¢ Network Project Pyramid--National Technical Asslstance uad Resource Sharing Project Drug Classification/Abuse Liability Abuse Liability Studies Volunteer-Based Prevention of Youthful Drug Problems Immigrant S~ial Service Youth Program Project Info: Drug Abuse Prevention in Youth Channel One Community Development Project Nom~ Community Center Program Charlotte Primary Drug Prevention Program Ticada Theater Drug Prevention Program The Alpha Center for Drug Prevention NAPA Experiment in Drug Abuse Prevention Impael of Georgia Drug Abuse Prevention Program Family Counseling C[irtic Center for Multicultural Awareness Prevenlion Services to High-Risk Populations Familial and Social Factors Associated with Drug Use Re~earch Scientist Developmeat Awards 1979 1980 RegQur¢~$ R~ourccs $ 115.964 $ I21.388 98.372 1.16a.642 1,514,66] 213.000 1,219.000 176.904 166.841 209.900 118,756 85.413 1.271.066 400.0(~ 138.223 114.961 105.585 73.552 78.452 79.754 457,404 429.545 107.662 124380 136.545 145.956 298.75I 361.523 171.202 214.938 65,000 22,000 II1

Food and Drug Administration Health Services Administration 112 t2. Misuse of Alcohol aqd Drugs Psychology of Prevention Clearinghouse: Primary Prevention Activitie~ Stale P,eventlon Coordina~o~ Prevention S~rvlces Program (SPG) Comparative Evaluation ill Egypt oI Voluntary Treatment of Opium Dependents (with the Office of International Health. OASH) Study in Yugoslavia of Comprehensive Social- Psychiatric Methods in Alcoholism Treatment (with the Office of International Health. DASH) Bureau of Drugs Drug Abuse Treatment Monitoring Prescription Drug Labeling Human Drugs: Bio-Rese~arch Monitoring Biopharmaceaties Drug Quality Assurance New Drug Evaluatioh Drug Efficacy Study Implementation Drug Experience and Trend Analysis OTC (over the counter) Drug Evaluation Prescription Drug Advertising Drag Lfstlng Bureau of Medical S~rviees Health Education Program (Uniformed Services University of Health Sciences [USUHS]) 1979 1980 Resources ResI3llr ces S a3.000 $ -- 305,000 1.409.611 1.700.000 -- 3.100.000 a a a a 2.133.000 1.526.0~0 1.592.000 1.872.(~00 7.896.000 7.529.000 4,246,~ 4,530.000 26,987.000 26.082.000 14,996,0C0 16.258.000 4.426.000 4.~27.g00 2.398.000 2,489.000 2.666,000 3,445.000 794.000 g30,O00 d d 81,000 945.000 I 0 .I

National institutes of Health Office of the Assistant Secretary for Health Office of Human Development Services 12. Misuse of Alcohol and Drugs Indian Health Service Clinical Scrvlccs Division of Re.arch Resou~es General Rematch iT~ Alcoho]/D~ug Misuse Nalianal In~itule on A£in~ Program to Red'Jc¢ the Inappropriate Use of Drug~ in the Elderly Office of Health R~ellvch, StatlsliCS, and Tech~olop~,/Na(~nal Center for He'affh ~ervices neq¢llrch The Effect of Education on Drug Utilization Adequacy and Validity of Data About Acute Poi~oning~ Ot't';~, of proffam C~,~inat/en 2~f Review Alcohol Abuse Prevcntlon Services (Title XX) Admlni~trat~n on A~r~ ldentLficatlon of Factors Affecting USe and Ef~ctiven~g Of Treatment and ~upport Services by Elderly Problem D~nkers--Olde~ Ar~erlca~s Act (Title IV-B) A Mode] Drug Educatlo,~ effect for Persons Working With the E1derly (Till¢ IV-C~ 1979 1980 g~gourccs RC~OLI~C~ $ 8,692.000 $ I3,500,000 • 131,493 151,545 1,050,000 l,lO0,OOO 14,571.734g 45,634,819g • 164,204 /0,962 10,962 113

t,'l Improved Nutrition ~979 Tol.I S/407910~92 Public Health Service Center for Disease Control Food and Drug Administration Health Resources Administration Health Services Administration 114 1979 1980 Resourcc~ Rc~u~¢cs Bureau or Health Education Diabetes Nutrition Study $ 297,400 $ 2CO,000 Bure~tu of Srn~tllpox Eradication Nutrition Surveillance 2,?00,000 2,385.000 Bure~ttt of L~bor~torles Nutrition A~plied Research -- 1,01_~,0C~ Bore~u of ]Food~ Nutrhion 4,627,000 5,225,0~0 Food Sanitation Control 40,639,000 41,286.000 Interstate Tmve] 3,094.000 3,177,000 Food Servic~ 1,813,000 -- Food Economics 1,822,000 ] ,949,00~) Bureau of Health Professiees Development of Independent Study Packages for Residents in Family Practice Programs--to Enhance Their Expertise in Providing Their Patients with Sound Nutritional Care 82.600 -- Development Grants--lnterdisclpIinary Training in Nutrition for Health Professions Students 1,500,000 1,500,000 AIlicd Health Educational Projects in Dietetics 9~5~000 466,099 Bur~u of Community Health SerYiees Enhance General Physical and Emotioual We]I Being--Reduce the Incidence of" Di~order~ Related to Malnutrition 6,000,000 7,000,000 g

National Institutes of Health 13. Improved Nutrition 1979 1980 ReSOUI'CeS Regonre@$ Indian Health Service Clini~al Ser~ice~ a~d Preventive Yi~aBh $ 4.655.352 $ 4.g9z.36~ Inter•f flee Programs Nutrition Education and Counseling in Primary Care Programs (IHS. BMS and BCHS) 2.774.000 b Di,ision of Research Resources Improved N0tridon 3 ~ 6,440 364.670 National Cancer Institute Information Dissemination--Relationship of Diet and Nutrition in the Etiology of Cancer 412.000 440.(;00 Nutrition and Cancer Studies Focusing on E~iologi¢ Factors Related to Nutrition 10.5(~.¢O0 12.'t05.000 Nalional Eye Institute Enhance General Physical and Emotional Well Being/Reduce the Incidence of Disorders Related to Malnutrition 613,305 1,065,812 National Heart, Lung, and Blood Institute Nutrition Counseling Program at University of |owa~ffects of Long-Term Couns¢li~tg on Nutrition and Heart Health 150,0~ 175.000 Lipid Research Cllnlc--Nutritlon Education for Participants and Families 1.000,000 1,025,~0 e •I "1 •1 01 IIJ

]]6 13. Improved Nutrition 1979 1980 National High Blood Pressure EducaI~c.n Prograril Plans for National ]~ducatlo~ Program on Nutrition for Hypertension Patients $ 2(;0,('/00 $ 250,000 Fle~rl Health N~Irifion Edu~mion Jn C~feterias, S~pcrm~trkcts and Vendinlg Machincs-- Filo{ S~udies 63 .COO 25,000 Lipid R~carch ClJnics--S~ree~ing ~nd Trcalme~t RcferraI on Hyperlipidemla, Counseling for Siblings and Spouses 1,800,000 f ,900,000 Stanford Nutrition Education and Counseling Programs %O,~0 700,000 Nationa[ Research altd l)emonstrat]on Cen~er, Baylor College of Medicine Risk Awareness Educatioa for Consumers in Heart l)]scasc al~d Nutrlt~on 800,0~0 900,000 National lnslitute oa ARinl~ NtJIrltJo~ Res~ar¢12 and Prcventio~ 1.159,~ 1,100,000 Enhance General Physical and Emotional Wel]-Bclng/Reduce the Incldenee of Disorders R~l~ted ~o Ma]~ntrJ~Jon 110,2~0 207,0~0 Clinical N~¢rlt~on Research 220,000 312,000 National |~lstlcate o| ArlhtJli~. Me~boB.*~m, ~ltl Kidney, Urologic, and Blood 1)isc~se 2,142,,°A4 !,,~7,~5 Artbritis~ Bone. and Skin Disease Programs d45,193 311,470 D~gestlv~ D~seas¢ and Nutrition 2,9'79,918 1,752.653 I el

Office of the Assistant Secretary for Health Office of Human Development Services lf . Improved Nutrition 1979 1980 Resources Resources $ 460,000$ 510,000 • -- $ 40,000,000 40,000,000 • 254,546 320,0(~,000 • 34,048 -- • 411,062 -- • -- 185.000 • 16,346,071 24,955,0'26g • National Institute of Neurological and Communicative Disorders Rnd Stroke Enhance General Physical and Emotional Well-Being/Reduce the Incidence of Disorders Related to Malnutrition Office nf Heallh Research. Statistics, and Technnlogy/National Center for Health Services Research Sercening for Cholesterol--Cost and Effectiveness Administration for Children. Youth. and Famille~ Head Start Nutrition Program Administration nn Aging Nutrition Programs (Title Ill-C) Nutritional Care Services for Elderly Subscribers Provided by HMOs (Title IV-B) Analysis of Food Service Delivery Systems Used in Providing Nutrition Services to the Elderly Technical Assistance and Training for the Aging Organizations in Management of Nutrition Services Office nf Program Coordination and Review Home Delivery and Congregate Meals (Title XX) 117

Public Health Service National Institutes of Health Office of the Assistant Secretary for Health 118 14. Physical Fitness and Exercise 1979 To!~ ga.~8f 6,~3 Division O[ Re,earth Resources Ex~rcise and Fitness National Hearl, L~nR, and Bloed lnstilule S{anford Heart Dilate Prc','enIlon P~oE, rant Exercise, Risk Reduction. and Heart Disease N.tional l.stitote on Aging Exercise and Aging; Exercise and Normal Aging Changes Prevention of LOSS of Body Funetlon President's Council on Physical Fitne~ and Sporls Technical A~sistanc¢ Services--e,g., FcderaI Employee H~alth/Fimess Programs. Blue Cross- Blue Shield, Union and Company Fitness Programs and Professional Societies Information Diffusion--Development and Distribution of Pub/~c a~d Professlona] Edueatlonal Materials. Bibliographic Services with the Na~iona{ Library of M~icine, Medical Symposia. and Research Seminars National Conference on Physlcal Fitness and Sports ~0r AI! Public Service Information Programs--TV. Radio, and Public Advertising Campaigns ~979 Resonrc~ S 75,523 3CQ,(~O 900.t~0 272,C~0 1,570.200 24,000 60,000 90,000 160,0CO 1980 E Resources ¢~ $ 87,036 300,000 900,000 260,0~30 2.374.000 32,t?~0 • 60,000 • 170,O(X) • !

Office of Human Development Services 14. Physical Fitness ~nd Exercise ,coo,,o,,~,, Physical Fitness Opportunlties--Work with I~dustries and Voluntary Groups to Promote Sports and Fitnc~ PrOjects, c.g,, Presidential Sports Award, Competition and Development Projects, "State Champion" Schools, and Certi~cation of Demon~tratlon Center Schools Leadership Training--4,500 Persons Trained in Regional Clinics in 1979 Technical Assistance to Governors' Councils on Physical Fitness and Sports Program Management Supporl Atlminislr~t[ion on Aginst Yoga and Relaxation--Meditation as Prcvet~tlvc Health Care for Older Persons (Title IV~B) ~a I979 I980 RC~OlJTCC~ ~ego/tr Ce'; G2 $ 29,000 $ 17,000 • 40,(X~ 21,000 • 635,000 300,000 • 25,920 <: ~.E t 119

Public Health Service Alcohol, Drug Abuse, and Mental Health Administration 12o 15. Control of Stress and Violent Behavior National Insfitul~ for Menial Heallh Foster Children: A Crisis Intervention Evaluation Effeet~ Of Spousal Illness and Death in Older Familie~ Stress and Families: Changing Sex Roles and Mental Health Services Study on Processes by Which Stress in Marital Relationships is l~¢lated to Psychosomatic Complaints During Pregnaocy and Subsequent Digruptlon of the Parenting Process Cr~sls Co~nsellng with Divorce Mental lllness and Divorce Studies of Stress-Resistant Children and Adult~ Psycho[oglcal Sfress and High-Risk Pregnancy Effects of Psych•logical Stress on Respiration Stress alld Persorlality Interactions in Health and 111tlcss Psychological Reactions to Uncontrollable Life Events Study of the Process of Ncl~rotlc Resp~ynsc5 Io Stres~ Study on the Effectiveness of Social Sul>port Relationships in Reducing the Negative Physical and Psychologlcal Impact of Job Loss Social Origins of Stress Study on the Transition of Rural Youth From Adolescence to Adulthood 1979 $ 136,010 306,301 300,179 46,835 28,214 106,641 181,885 6,793 6,824 50,993 14,42] 185.987 50.102 133,598 85.013 1979 Tota~ $7,538.812 19~0 TOIRI $6.284.49t ~980 R~ources ~ ~ ~*~ $ -- • 310.357 • 128,716 • 50,293 • , -- Oi -- OI 67,324 D¢ 260,000 - •]

Health Resources Administration National Institutes of Health !5. Control of Stress and Violent Behavior 1979 Resources Adaptation and Stress Among Vietnamese Refugees $ 65,750 The Economy as Stressor of Metropolitan Populations 145,253 Family Coping Following Job Loss 91,551 Private and Social Response to Job Loss: A Metrostudy 96,846 Life Changes and Illness: A Multicultural Approach 146,894 Stress Inoculation and Adherence to Health Decisions 63,359 Coping with Long-Range Stress of Trauma and Migration 8,693 Stressful Life Events Rating Problems in Epldemlology 13,CO0 Bureau of Health Professions Supportive Care by NurSes for Children Hospitalized for Major Surgery 50,280 Dealing with Stress of Both Patients and Nurses in Intensive Care Units 146,311 Division of Research Resources General Research in Stress Control 72,714 Nationat Heart, Lung, and Blood Institute National Research and Demonstration (in cardiovascular disease) 4CO,000 Type A-B Behavior in Patients g5,CO0 1980 ff Resources ~2 $ 57,745 159,445 67,324 14,984 66,179 15,473 83,758 • 700,009 • 125,000 • 121

Office of the Assistant Secretary for Health office of Human Development Services !5. Control of Stress and Violent Behavior NaHo~[ [tlstltule ou Al~in~ Societal Rmearch Studies on the Effects of In~titutionalization and Relccation Enhanced General Physical anti Emotional Well P, eing/to Improve Psychological, Social, and Medical Status of the Elderly Of Uw¢ of l'lealth Research, S~fl~ics, ~nd Teehllology/N~lionll CcN~r [or Health S~rvick-~ Res~reh Support Systems, Stress, and Primary Health Care Slress and the Amish Community in Transition Human Population Laboratory for Epldemiologic Studies ofrwe of Prognlm Coordi~don and Review Mental Health Program (Title XX) Administration on ARIn~ Survival Techniques of Older Americans irt Economically Stressful Circumstances (Title IV-B) Capacity euiMircg and Model Development for the Delivery of Mental Health Services (T~tle IV-C) Effective Cornmanity Intervention for the Elderly (Fitie IV-B) 1979 1980 Reso~Fcc~ Resources $ 285,009 $ 451,000 • 3,670.000 3.136,000 148,377 170,627 -- 24,069 WO,O00 d d 28.948 86,0a0 93.675 -- 159,522 g @ 122

O|fit;e oi Human Development Services 15. Control of Stress and Violent Behavior ~co~,,..~o~ Atlmin~,tvation olt Agi~ (to.tlnu~,~) Area Agencies on Aging and the Provision of Mental Health Services for the Elderly (Title IV-B) A Model PrOject /or Enhancing Meaning of Life /or Hispanic Eiders (Title IV-C) 1979 1980 Resources R~out'ces $ -- $ 143,000 200,000 t 123 m

Public Health Service Alcohol, Drug Abuse, and Mental HeaLth Administration 124 16. Cross-Cutting and Other National Inslitute of Mental Healtll Adolc~cems and Adults at Genetic Risk for Psychosis Sludges of Schizophrenic prone Young Adults Memory Training for Ihe Community Aged Eincrgent Self-Help Networks Among Urban Elderly Factors Regulating Family Environment Interaction Dual Work Faml]ies: New Sex Roles or Old Changing Family Behavior and the Organization of Work Marital Separation and Medical Utiliz2,tion Maternal Separation: A Biobehavioral Followup Therapeutic Infant DevcloI~ment Program An Infant Menial Heallh Program Development and Implemenlatlon of a Cllnlcal Infant Research Program Identifying Preschool Children at Risk Prospective Study of Children of Schizophrenic Parent~ Mental Health of Children in Pediatric Care Adjustment of Children of Schizophrenic Parents Achievement Ptace: Ph~ts¢ III--Youth Mental Health Children in Danger: A Prospective ~lndy 1979 Total S 914.299.508 1980 Tolal S~,169,20~,549 l// 2 1979 1980 C ~ ~ Resourc¢~ Resources ~ ~ /~ $ ~2.76I $ -- • 146,036 1~,765 • 63,319 -- • 123,170 -- • 132,068 150,000 • 56,176 ~,794 • 6,900 -- • 55.150 • ~,852 • 162.845 • 127,155 -- • 280,000 -- • 133,g21 1~,525 • 3~.786 -- • 1~,I96 -- • 194.065 • 2~,(YJ(I 302,042 • 47,942 i •

!6. Cross-Cutting and Other co,, 1979 1980 Resotl~ce~ Resou~ce~ Youth Mental Health Project S 110,377 S Adole~cnt Development: Sleeping and Waking Behavior 27,835 28,138 Service Needs of Children at Risk of Schizophrenia 18,607 30.330 Behavioral Study of ChiIdren of Schizophrenic Parents 57,405 58,900 ChiIdren Vulnerable to Psychopathology 32,400 Developmelltal Processes in Children of Schizophrenic Parents 15.200 Children and Families Vulnerable to Mental Disorders 434,105 177,I56 Social Work: Special Training Project 56,048 56,048 Primary Prevention Component in Mental Health Training 21.18l 22.875 Mental Health Skills for Urban Trade Unionists 106~596 109,139 Preventive Mental Health Training: High-Risk Elderly 35308 36,210 Child Psychiatry Training: Detection of High Risk 62,584 62,584 Training Program in Management of Stress Response 133,982 134,673 Obesity and Cultural Correlates. a Puerto Rican Case 6,900 -- Epidemiologieal Analysis o[ Type A/B Behavior 236,499 168,255 Profile: Black Males at Risk to Low Life Expectancy 131,663 116,002 ..o g 125

Cross-Cutting and Other Quality of Work and Mental Health in an Urban Agency Community Action Strategies to Stop Rape Structurally Induced Social Probiems and Mental Health Aria ys s of H gh-Risk Psyehophysiological Data Coping Behavior in Schizophrenia Neonatal Factors in Serious Mental Disorders Schizophrenic Offspring from Birth to Adulthood Community Mental Health Centers--50 Percent of Consultation and Education Parent Training: A Preventive Mental Health Program Indigenous Caregiving Networks in Primary Prevention Training Training in Preventive Mental Health Services Education/Training: Childhood Primary Prevention for Agencies Under Threat of Mr. St. Helens: A Study of Chronic Family Stress Jobs. Job Search, Social Support and Depression Children at Risk for Affeetive Disorders Effects of Divorce on Children--Preventive Primary Prevention in Divorce: A Long Term Follow-Up 1979 1980 Resources 1~esoure~ $ 19,172 $ -- 50,723 I01,904 13,177 144,472 89,733 53,819 65,422 6,664,000 4.650,C~ @ 95.195 113.115 86,717 84,573 86,414 59.155 -- 140,000 -- 71,343 78,049 -- 63,627 64.359 O el el Ol ol ol ol Ol Ol 01 Ol ol el Ol Ol Ol 126

7 Cross-Cutting and Other 1979 F'lenal%~ Conference of the Risk Re.arch Consortium $ -- P~-ental Mental Illness and Outcome in At-Risk Children Studi~ of Persons at Risk [or Depr~'$sive Disorders Program Impact on Children Of Mentally 111 Social Support and Mental Heath in a Btack Community Coping Styles of Black Adolescent Families GAIN Program: Grou~ Activities for Individual Needs A National LongRudlnal Study of Marital Disruption Evalu~ion of Families and DivorCe Workshop ~,~luntary R~tio~ and M~I Health of the Aged Patterns of Dif~rentia[ Responsiveness to Stt-es$ Short- and Lons-Term Effects of Broken Homes on Children Sequela of Marital Disruption on Children Stress, Illness, and Cooing [n a Rural Connecticut TOWn B[~ck Family Mental Health and Teenage Prcgnanoy Cognition. Speech, and Vulncrabillty to Schizophrenia u // 19 o E $ 19,487 • 151,207 • 45,453 • 198,631 • 123,939 • 72,960 • 149~973 • 270.049 • 62,739 • 60,000 • 46,312 • 167,088 • 25,174 • 29,895 • 260,689 • J 70,600 • I 127

128 16, Cross-Cutting and Other co. .ued) 1979 1980 ff Carillg for Elders and Mental Health of Family Members $ -- $ 150,000 Social Support, Strains. Wel[-Being of Divorced Women -- 67,300 Teens and Mental Health: A Prevention Currieu{um -- 111,450 Preventing Psychopathology in Children of Divorce -- 62,959 Sex Differences in Morbidity and Health Action -- 149,878 Impact of Mental Illness on Patients' Families 15,000 A Longitudinal Study of Schooling and Delinquency 135,541 Adjustment of ChiIdren of Schizophrenic Parents -- 71.700 Impact of Affectively III Parents on Their Children -- 130,248 Can We Predict the Mental Health of Young Black Males? 112.903 /mpact of Marital Disruption on Navajo Children -- 120.000 Training in Preventive Approaches in Mental Health -- 137,917 Resources, Stress, and Menial Health of Older Persons -- 321,411 The Social Network as an Alterr~ative Resource -- 11g,6~6 Wives' Emoloyment) Rote Demands, and Adju$lment~ -- 17,D41 Reliability and Validity of the Divorce Problem Inventory -- 14,974 ~.L: 0 0 0 0 0

Center for Disease Control 16. Cross-Cutting and Other Program Management Bureau of Health Education A Collection of Literature and Program Information in Health Education CDC Lifestyle Project (Health Hazard Appraisal) American Hospital Association Patient Educa(ion Project Self Care Projects School Health Curriculum Project Grant Program to Deter Smoking and Alcohol Use Among Children and Youth (Transferred from Office on Smoklng and Health) Identification of Industrial Needs and Development of Health Education Guidelines for the Health Insurance Consumer Other Health Promotion Projects Bureau of Epidemiology Diabetes Control Demonstration Projects Chronic Disease Control Studies/Cancer. Arthritis, and Other Diseases Bureau of State Services Urban Rat Control Grant Program ~nl 4~nntrnl Pr~r~m- T~,~hnle~l A~ci~t~nc~ Office of the Center Director lleahh Incentive Grants (314d) 1979 Resources S 174,009 50,000 300,009 722.000 155,000 2,600.000 10,4~,000 2 f-a~o 0o¢~ 90,000,000 1980 Reqonree~ $ 3,851,0~) 297,000 1,146.000 • 383.~0 • 1,207,000 • l 0,0(~,000 • 6,667,000 • 4,600,000 • 909,C~) /// 14,000,000 • 68,009,000 0 129

Food and Drug Administration Health Resources Administration Cross-Cutting and Other 1979 1980 ResouTC~ Beso~rC~ B0reau of VelPriaary Medicine Animal Drug Safety and Efficacy $ 9,065,D00 $ 9.135,000 Animal Feed Safety 4,758,0C~ 4,932.000 Drug and Chemical Residues in Animal-Derived Foods 2.112.~0 2.187.000 Veterinary Drugs: Bit-Research Monitoring 2,329,000 2,417,CO0 Btlrtmu of Medical Devices Premarket Approval Activities 5.336.(Yl0 4.809.0(30 Monitoring and Quality Assurance 18,932.000 19.519.000 Standards Activities 3.770.~0 4,1 gg,(~)0 hwestlgatlonal Device ExempUons 4.106.~ 6.693.~0 Bateau of Biologics Biologics Safety. Efficacy. and Labeling Review 923.000 953.000 Biologics: BimReseareh Monitoring 5.071.000 5.415.000 Office of the Comm/ssioner Program Management 39.~93.000 40,303,~00 Buildings and Fa¢ilille~ 4.372.000 d.372.000 Bureau of Health Professions Develop. Implement. and Evaluate Learning Modales to Teach Co.~mual¢~t~o~ ~.~1 E~tJent Education Skills to Physicians in Primary Care-- University of Wisconsin 78,450 -- r~ 0 130

,/o, ,"~,,,.~ ~,jl~! n0 ~n.'t Nthnr ~,-~.,. ......... Develop Curricular Modul~s in Occupational, ladustrlal, and Environmental Medicine for Integration into Primary Care Training Programs Research to Develop an Electronic Monitoring Device for Paralyzed Patients oil Bladder Control Exl~erimental Program on Recovery and Rehabilitation from Heart Attacks Research on Relationship of Maternal Anxiety and Physiologlcal Measurements Curriculum Development Grants to Develop Instructional Materlals to Agsist Medical Students in Proteeling Consumei'5 from Exposl~re to Environmental Factors, with Focus on Preve)atlve M~dieine Preparation of Teaching Tools for the Education of Children in Relation to Nutrition, lmmunlzations, Exercise, etc. Publication of Phase 11 of Longitudinal Study of Nurse Practitioners, Focusing on Employment of NPs and Their Impact on Health Delivery Study on Role Delineation for Entry-Level Health Educators, Including Aspects of Prevention Research/Data Contracts on Institutional Information About Schools of Public Health, Where Trahiltlg indades Prevention (e.g., data on students, faculty, graduates) 1979 ]980 Resource~ Resources ~-~ $ 410.470 $ -- • 174,431 267,042 103,482 977,234 146,831 -- • 6,730 -- • 204,450 359,682 98.!22 ¢.¢ 131

132 16. Cross-Cutting and Other ~co.,.,.o..~ VeriFication and Refinement of Role Delineation for ENtry Level Health Educators, Including Aspecls of Prevention Public Health Traineeships with Focus on Prevention Public Health Special Projects with Focus on Prevention Develop, Implement, Evaluate and Disseminate a Sell-Learning Program in Alcohol and Alcohol Abuse Evaluation of P.L 94~84, Sec, 788(d) Grants for Curriculum Development in Nutrition, Gerialrics, and Environmental Health Development of Master's Level Course in Nursing for Care or Individuals in Correctional Commundies Bureau o[ Health Planning Variety of Activities Carried Out by the State and Local Health Planning Agencies (see discussion under Agency Innovations section) Office of International Affair~ Study of Health-Related Beliefs of Urban Egyptian Children with View Toward Developing El[ective Health Education Program~ (with the Office of International Health. OASH) 1979 Re~OuI'cc~ $ 2.500.000 1,700,000 I980 Re~onrces $ 239.292 2,500,000 2,800,000 126.487 65,034 290.754 /// ~ e s~ wI

Health Services Administration Cross-Cutting and Other 1979 ~980 ~CSO~rC~$ Office of PIHmin~, Evalualioa and Legislation Development of Hational Guidelines for Health Planning--Component oF Health Planning Goals Focuses on DiSe~L~¢ Prev~ntiot~ and Hc&Ith Promotiotl $ d $ d Bureau of Communily Health Services Community Health C~nters/Dental 1,750.000 2.170,(X~O Migrant Health/Dental 575,000 660,000 Maternal and Child Health/Crlppl~l Children/Dent al 3.600,000 3,600,~0 National Health Servi~e Cor]~s/Dental 1,250,000 1,470,0CO Hearlng and Vislon ~rviees 24,775.000 24.265,000 Burelu of Medlcal $etvle~ Program to Reduce the ln¢~d~ence an~ Promote Early DiagnOSis of Chronic Disease 16.105,360 b ]Program ~o ,~¢du~ ~he Prevalen~.'e of ~*'~en~al HealJh ]Problems and SubslarJee Abuse 3,8~4,000 h Primary M~nt~.l Health Counseling aad Treatr~¢nt Program I,l .~9,000 b Dental Services 12,516 13,639 Indian Health Service Pr[mary~ Mental Health Counseling and Treatment Program 6,200,0£0 ~,571,~,~, Clinical Service~/Dent a[ 14,431 ,¢~0 15.595,000 0 ]33

"~,. C:,oss-Cutth~9 m~d Other ,,,~ ........... National Institutes of Health 134 1979 Resources 1980 Rcgourcqs In(eroffice Pro~ms Education in Primary Services (BCHS. BMS) $ b $ b Health Edl ca on and Coun e ing in All Prlmarv Care Programs (BCHS, BMS, IHS) 47.318,828 h Coping/Stress Management: Primary Mental Health Counseling (BMS, IHS) 3,000.000 b Division of Research Resources GeneraI Research on Cross4Cutting Issues 714,060 g23,002 Fogarty nteruational ~flter International Research Fellowships (post-doctoraD 250,000 250,000 National Cancer InsBtute Cancer Centers Program 3.670.1300 3.700,CQ0 Epidemiology to Identify Groups at High Risk of Cancer 14.794,000 16,569.000 Traitfing of Research Personnel 6.174.500 8,337,000 Tumor Biology Program 4.080.000 5.d00,C~0 Biochemical Hazard Construction 8,214.000 3,087,CO0 International Cancer Research Data Bank 175.000 360,000 Na ona Eye lnsBtule Cataract 67d,(-~37 R7R 451 Glaucoma 530.655 503.684 Scnst)ry and Motor Disorders of VSslon 416.613 448,296 Retinal and Chornidal Diseases 4.361,972 5,'~20.951 Corneal Diseases 695.640 834.842 .g ./E -=~ ~ g 0 0 ol ol ol 0 OI

c Ooss-Outting and Natlonal Heart, LUnR, and Blood |nstitute Commobity Etiuca(~on Project 5 Communities Risk Factor Awarcn~"~s. Education and Trealment Study at Stanford University Multiple Risk Factor Intervention Trial. Heart Health Nutrition Education aad Counseling Programs--Individual and Group Based. Family Assistance Also Provided Multip]e Risk Factor Intervention Trial (NHLBI)--Screening and Treatment Referral on Hypertension. Cholesterol, Weight and Smoking; CounseIing for Siblings and Spouses Multiple Risk Factor Intervention Trial--Use of Stress Management Technlque~ for Nutrition and Smoking Counseling liemophilla and Sickle Cell Disease Prevention Research Coronary Primary Prevention Trial (CPPT)-- Medication Compliance Program Oiabete~ and Cardiac Function Ri~k Factor Identlfieatioa--Role of Trace MetaIs in Congenital Blood Disorders National |nstffute ol Aging Program to Reduce Functional Disability in the Elderly .¢ ~e~oLirce~ 2,000,000 $ 2.100,000 • 4.200.000 4,250.000 • 1300,000 1.750,000 • 4CO.000 750.000 • 1,960,000 1,960,C00 • 345,000 350,000 • 600,000 675.000 • 310.000 310,000 • 400,000 9~,000 @ 135

136 16. Cross-Cutting and Other 1979 1980 Resources Re~nurce~ Risk Assessment of the Effects of Social, Psychological. and Demographic Changes in Aged Populations National ln~litnte of Arthritis. Metabolism, and Digestive Diseases Intramural Proj~t$ Related to Primary Prevention 665.000 b Contracts Related to Primary Prevention 345.404 261,412 Nalional In~tilute of Dental Research Dental Research/Applied 3,699,895 Studies of Pain Control and Fear of Dental Pain (rest and refaxation) I I 1.261 National Institute of Dental Research Studies/ Basic Science 3.811.156 National Institute of General Medical Sclenees Research to Prevent Chromosomal Abnormalities and General Genetic Diseases 849.700 I ,I41,000 Research to prevent Metabolic Disorders 68.591 35.538 National Institute of Neurological and Communicative DL¢orders and Stroke Research to Prevent Neurological Disorders and Stroke/Basic Research, Screening, and Epidemiology 14.000.00~ 15.960,000 $ 1,344.000 $ 1,500,0~0 t , L

l Office of the Assistant Secretary for Health 16. Cross-Cutting and Other (Cor tinued) Research to Prevent Neurological and Communicative Disorders and Stroke/Enzyme Metabolism Abnormalities Stroke and TraBma Program Fundamental Neurosciences Program Neurological Disorders Program Communicative Disorders Program Protection of Vision and Hearing [iItramura[ Research P~ogtam Inlet-Institute ProRrams Scientific Conferences to Evaluate RePent Research Results Related to Preventive Medicine (FIC and other BIDs) Senior International Fel]owshi!vs for Research Related to Preventive Medicine (FIC and NIAID) Office of Di~e PrevenSon lind }]~llh PromolioA/Offlee of Hcallh llformation, Health Promothm, ~nd Physical IFitne~ anti Spnrls Medi¢iRe National I-]ea]th Information Clearinghouse Conferetlc¢ in At]anla, Georgia, to Develop Objectives in Accord wlth Surgeon General's Report Promot ion Programs 1979 1980 R~so~rccs Re~ource~ $ 3,300,000 $ 3.762.000 1,800,0(30 2.052.000 6,400,000 7.296,000 5.700,000 6,498,C~O 5,500,000 6,270~000 2,350,000 2,679,000 5,2CO,000 L928,000 200.C~)0 200,000 • II0,000 II0,OC, Q 375.938 373,000 • d -- • 139,609 -- • 137

Cross-Cutting ~nd Other ,c~.,., ....... 138 National Health Promotion Media Campaign-- M~:ting [o Define Ways to Use Broadcast Media Io Promote ~cahh Regional Forums on Community Health Promotion Meelings to Coordinate Studies of Ht'a]t]~ Risk Assessment Meeting to Explore Development Of Self-Scorlng Health Test Collaboration with Bureau of Health Education on Evaluation of School Health Activities National Conference on Promoting Health in the Schools Demonstration Project Related to Health Promotion Services in HMOs Survey of Heltlth Habits--Conducted Through the National Center for Health Statistics Health Message Testing Service--Participation in NCI and NHLBI Program Office of Health Researeh, Statistics, and Teehnolozy/Nutional Center for Ilealth Services Rt~eareh Systematic Health Intervention Oi~dvanlaged Groups Increasing Healthy Behavior: A New Technique Description. Analysis, and Assessment of Health Hazard/Health Risk Appraisal Programs 1979 1980 Resourc~ Resources . 2O0,000 $ 143,000 • 10,000 1,500 • d d • 6,750 d • d d • -- 74,000 • -- 130,626 • I I7,000 70,000 • 50,000 68,000 • i6,37g 151,514 • 2~ e s~

1R. Cross-Cutting and Other Case Studies of Health Promotion and Disease Prevention in the Workplace Synthesis and Disseminalion of Research Findings on Health Promotlen and Disease Prevention foterventiorl Strategies Collaborative Study with India of Systems Analysis Approach for the Delivery of Primary Health Care (with the Office of International Health, OASH) Evaluation Of Breast Cancer Detection Strategies Self Care: Practices and Attitud~ in the United States Quantitative Measuremem of Quality of Medical Care--Sentinel Health Events Hollstic Health Center Orientations and Characteristics A Study in Policy Activation: The Case for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Common Senge--Common I-lea[th ]Evaluation Office of Population Affairs Immunization and Family Planning Pregaancy and FamiIy Planning STD and Family Planning 1979 Resources $ 203,460 189,589 a 78,398 59,562 9,166 29,221 1,347 4,(X)O I,I)30 2,000 / /" Resources r~ ~ ~ ~ $ OI a 68,177 • 75,138 • 4,090 • 1,000 • 2,000 • 139

, i! .... 16. Cross-Cutting and Other coot ..ed Health Care Financing Administration Office of Human Development Services 140 Office of Special Programs Early Periodic Screening, Diagnosls. and Treatment Program (EPSDT) Office of Re=search. Denlons[ra(io,~. and Statistics Demotlstration project~ to Improve Psycbo~og~ca]. Social. arid Mec]ical SIa~us of the Elderly Adminislralion an Aging Comrtlunlty-Ba~ed Comprehensive Care for the Elderly (Title IV-C) Promoting Wellness of the At-Risk Elderly and Their Fami[ie~ in Scrvio~- ~moti~traflot~ Pro~c¢~ (I itle IV~C) Senior Health Services Project (TIt[¢ IV-C) Providing a Missing Link in ~he Chaln of National Support (Title IV C) Services to Homebound Elderly (Title IV-C) Senlor Ceatey Care System (Title IV-C) Identifying and Enhancing 1he Natural Support Systctns of the Nonlnstltutionallzed R~ra] Elderly (Title IV-C) Health Education and Social Service/Primary Care Coordination Dctaorls~raiion Project ~t a Rural Area (Title IV-C) DemohstraAion project on Elderly Abuse (Title IV-C) f979 [980 Rcsources ~e~o~fc~ $ 49,000,000 $ 52.8~1,388 • d 344,489 • 193,802 193,802 • I37,763 141,263 • 190,621 190,621 • 112,593 112,g53 @ 90,003 • 17i,894 165,048 • 89,550 89.550 • !O0,__c~ 50,000 • -- 125,0~ •

16. Cross-Cutting and Other r. 1979 1980 Resources Resources Training, Research, and Discretionary Projects (Title IV-A) $ 3,709,699 $ 4,460,586 Training, Research, and Discretionary Projecls (Title IV-E) -- 160,000 Administration on Aglng/Health Services-- Administration Demon~tratlon Projects (Title IV-421) g36,gO0 425,32~ • Older Americans Health Fair Project of Health Screening and Health Education (Title IV-421 ) 451,213 -- • Admini~trallon for Children, Youth and Families Eleven Demonstrations of Community Action to Prevent Child Abuse and Neglect 936.000 -- Five Demonstrations of Child Protective Agency Management of Self-Referrals 300,000 -- Intensive Supportive Services to Prevent Separation o f Families-at- Risk 1,190,160 1~200,0~ Seven Demonstrations National Research Coordination Contract 145,000 -- Eight Demonstrations to Plan and Initiate Comprehensive Emergency Services Systems 90,000 270,000 To Keep Children Healthy and Promote Early Diagnosis of Child Health Problems/Head Start Screening Programs 11,970,0~ 12,000,C~) • National Runaway Switchboard Program, Inft~rmalion and Referral 260.000 260,0CO • Eight Youth Development Demonstration Grants 600,000 653,606 • Teenage Pregnancy and Parenting Program 95,000 95,000 • g 141

142 la Cross-Cutting and Other,coo, ,,,o:, Health Provider Committee for Head Start, Information and Referral Health Education for Paren(s Program. Information and Referral 21 Community-Based Prevention and Treatment Service Improvement Projects Development of a Statewlde Model to Streamline Title XX Systems for Effective Utilization by Runaway Shelters--Ohio Youth Services Net~vork, Columbus, Ohio (with APS) Demonstrations on Prevention of Child Sexual Abuse (six grants) Five Treatment/Training Institutes for Child Sexual Abuse Office of Policy Devtlopmenl Women's Alternative Center: A Residential Treatment Program for Female-Headed Households with Serious Problems, Wawa, Pa. Henry Street (NYC) Residential Treatment Center For Female-Headed Multi-Problem Families Family Support Center, Yeadon, Pa.--Services to Children Under 4 Years of Age Determined to be at Risk of Child Abuse aod/or Neglect 1979 Resources $ 24,0OO 360.000 1,980,000 150,000 99,500h 99,943i 93,705 1980 Re~qlluree~ $ -- • 1,980,000 • 150,000 • 352,216 • 1,070,000 64,200 • 93,705 • !!5,~eO3 •

C,oss-Cutting and Other 1979 Resoureos e Family. Child Resource Center for the Ute Mountain TribaI Council--For Child Care, Foster PIacement, Coordinllted Hunlan Services on Reservations $ 104,000 $ -- • Model for Social Service Cgtpability in Indian Tribes in North Carolina 120.000 -- • Indian Family Structure and Welfare Delivery System in Maine and M~lehusctis 110,050 -- • Comprehensive Social Service Plan for Standing Rock Sioux Tribes 93,110 -- • Sisseton-Wahpetoa Sioux Child ProR~etioa. Family SUpport and Placeraent Deraonstration project 68,916 • Indian Child Welfare Training and Demonstration Project--Five Tdbes~ Washington State Fo~ter and Adoptive Parents) New Statewlde ]u*'eaile Code 195,400 -- • Demonstration Model for Tribally Controlled and Operated Social Services System in Arizona (18 TribeSl I 3~,00) • Michigan Demonstration Model for Indian- ControLled Child Welfare Agency 138,816 -- • Office of Program Caonllaafon nod Review Homemaker, Home Managlmlent Services (Title XX) 374.980,278 597,310,688d • Day Care. !nfotma!~nn and Referr~ (rifle XX) d d • Health S~rvices (rifle XX) -- 92,424,682 •