I have just read the NIH priorities for the Challenge Grants to be issued under the American Recovery and Reinvestment Act of 2009. As a member of the Institute of Medicine Committee on Prevention, a member of a NIDA workgroup on prevention priorities, and as the Past President of the Society for Prevention Research, I feel compelled to comment on these priorities.
Despite President Obama’s stated intention to support prevention through evidence-based programs and comprehensive efforts to address the risk factors that put people at risk for multiple problems, the Challenge Grant priorities are wholly absent any funding that would advance the nation’s ability to prevent the psychological and behavioral problems that cost the nation more than $400 billion per year.1 What is sadly missing in the priorities is any recognition of the relationships among problems or any challenge to put together what we know to produce population-wide changes in wellbeing.
Psychological, behavioral, and physical health problems are inter-related for both adolescents and adults.1,2 These problems co-occur with a host of others, including major marital discord, unemployment, and on-the-job conflict.3,4 All of these problems are significant risk factors for physical illness.4 Self-regulation, positive behavior (e.g., physical activity and healthy eating), prosocial behavior, academic achievement, and job performance are also highly inter-related, and are negatively correlated with problem behaviors.5,6 Encouraging young people’s positive behavior can put them on a positive developmental trajectory that leads to happier and more productive lives.7,8 Yet despite the evidence, the Challenge priorities continue to focus on individual problems as though each was completely unrelated to any other and as if a common set of risk factors did not influence multiple problems.
Biological and behavioral research has brought us to the point where it is possible to substantially improve human wellbeing in most American communities.9 Yet actual wellbeing—especially in impoverished communities—lags far behind what the evidence shows could occur. The primary reason is that prevention science remains fragmented, with separate groups of investigators funded by different institutes and each studying different psychological disorders or physical illnesses. This disciplinary archipelago obscures common features involved in preventing each problem, and, up to this point, the NIH has not funded research to develop and test interventions that comprehensively improve wellbeing. The Challenge priorities miss an enormous opportunity to do just that.
A new synthesis is necessary. One of the highest priorities for NIH research should be the evaluation of comprehensive interventions that support the development of nurturing family, school, workplace, and neighborhood environments. The just-released IOM report9 on prevention provides ample documentation for the fact that environments that support positive behavioral development and reduce biologically and psychologically toxic events, such as abuse and conflict, can prevent multiple public health problems and can contribute to our lives being more caring, meaningful and productive.10 The next major breakthrough in public health research will result from creating and experimentally evaluating comprehensive interventions to increase the prevalence of such nurturing environments. Yet the Challenge priorities make no contribution whatsoever to this agenda.
NIH and NIDA in particular must modify the Challenge priorities to include some that foster the creation and testing of the kind of comprehensive preventive interventions that are commensurate with what the new administration is so clearly seeking to do.
Here is an example: Research is needed that tests comprehensive neighborhood and community interventions that have the potential to increase the prevalence of health and prosocial behavior and to prevent the development of multiple problems, including drug abuse, antisocial behavior, depression, academic failure, and risky sexual behavior.
If you share these concerns, please add your comments here and go to http://www.facebook.com/home.php?#/group.php?gid=65033804001 and add your name to those who urge NIH to strengthen its prevention research. As more people add their comments, the message will grow in strength. I will endeavor to make the website and its supporters known to the leadership of NIH and the White House.
1. Biglan, A., Brennan, P., Foster, S., & Holder, H. (2004). Helping adolescents at risk: Prevention of multiple problem behaviors. NY: Guilford.
2. Nock, M.K., Kazdin, A.E., Hiripi, E., & Kessler, R.C. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: Results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry, 48, 703-713.
3. Conger, R.D., Ge, X., Elder, G.H., Lorenz, F.O., & Simons, R.L. (1994). Economic stress, coercive family process, and developmental problems of adolescents. Child Development, 65, 541-561.
4. Roy-Byrne, P.P., Davidson, K.W., Kessler, R.C., Asmundson, G.J.G., Goodwin, R.D., Kubzansky, L. et al. (2008). Anxiety disorders and comorbid medical illness. General Hospital Psychiatry, 30, 208-225.
5. Flay, B.R. (2003). Positive youth development requires comprehensive health promotion programs. American Journal of Health Behavior, 29, 407-14.
6. Posner, M.I. (2008). Evolution and development of self-regulation: Seventy-seventh James Arthur lecture on the evolution of the human brain. New York: American Museum of Natural History.
7. Kellam, S.G., Brown, C.H., Poduska, J., Ialongo, N., Petras, H., Wang, W. et al. (In press). Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes. Drug & Alcohol Dependence, in press.
8. Flay, B.R., & Allred, C.G. (2003). Long-term effects of the Positive Action program. American Journal of Health Behavior, 27, S6-S21.
9. National Research Council and Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
10. Biglan, A., & Hinds, E. (2008). Advancing the goals of clinical psychology by evolving prosocial and sustainable communities. Annual Review of Clinical Psychology, 5.