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New Horizons in Health: An Integrative Approach 11 Research Infrastructure Several fundamental elements are needed to carry out the thematic priorities of this report . These include maintaining suitable study populations for long-term multilevel human and animal research , marshalling underutilized sources of clinical data , collecting new data on community-based interventions , and fostering scientists capable of working across multiple levels of analysis in the social , behavioral , and biomedical sciences . HIGH-PRIORITY HUMAN AND ANIMAL POPULATIONS It is essential to develop a mechanism for sustained core support of human and animal study populations , data bases , and laboratory animal colonies that can be used to study the integrated biopsychosocial pathways to diverse outcomes of both positive and negative valence . The relevant human populations are of two interrelated kinds: (1) longitudinal surveys , preferably involving multiple birth cohorts , based on sampling from population registries at the individual level; and (2) community samples , such as the Chicago Neighborhood Project (Sampson et al . , 1997) , the Los Angeles Family and Neighborhood Study , and the Framingham Study (Dawber , 1980) . 1 Community-level samples facilitate 1 The data are available electronically: Los Angeles Family and Neighborhood Study: http://www.rand.org/lafans.html; Framingham Study: http://www.framingham.com/heart/.
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New Horizons in Health: An Integrative Approach the study of collective properties of populations and local physical surroundings as they influence individual and overall population-level health. At least two options are available for developing core samples to facilitate the kinds of studies prioritized in this report. One option is to start new birth cohorts and community studies that are responsive to the integrated biopsychosocial lines of inquiry. The second is to take existing longitudinal and community studies that have strengths in particular areas (e.g., psychosocial factors) and add biomedical factors to them. In the case of the Framingham Study, for example, psychosocial data would be needed to augment the superb biomedical assessments that have been the basis for this study from its inception. As indicated in Chapter 2 and Chapter 3, there are few extant longitudinal samples that could be, even in principle, the basis for empirical characterizations of pathways over major portions of people's lives. The 1946 and 1958 British birth cohorts (Power and Matthews, 1998; Wadsworth and Kuh, 1997), the Wisconsin Longitudinal Survey (WLS; Hauser et al., 1993), the Alameda County Study (Berkman and Breslow, 1983), the Baltimore Longitudinal Study of Aging (National Institute on Aging, 1991), and the Harvard Mastery of Stress Study (Russek and Schwarz, 1997) are prominent examples of long-term studies that could be included in the core investigations of biopsychosocial pathways. Furthermore, it would be useful to add biomarker and other health-related data to the National Longitudinal Survey (NLS), the Panel Study of Income Dynamics (PSID), the Health and Retirement Survey (HRS), the National Survey of Families and Households (NSFH), and the Survey of Income and Program Participation (SIPP). 2 Correlatively, it would be useful to add psychosocial and socioeconomic data to the Framingham Study and to the longitudinal components of the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES). 3 The common feature of all these samples is that they are rich in either psychosocial or biomedical information but not both. A variety of possibilities need to be considered in 2 The data are available electronically: National Longitudinal Survey: http://stats.bls.gov/nlshome.htm; Panel Study of Income Dynamics: http://www.isr.umich.edu/src/psid/; Health and Retirement Survey: http://www.umich.edu/~hrswww/; National Survey of Families and Households: http://www.ssc.wisc.edu/nsfh/home.htm ; Survey of Income and Program Participation: http://www.sipp.census.gov/sipp/. 3 The data are available electronically: Framingham Study: http://www.framingham.com/heart/; National Health Interview Survey: http://csa.berkeley.edu:7502/cgi.bin12/hsda?harcsda+nhis19 ; National Health and Nutrition Examination Survey: http://www.cdc.gov/nchs/faq/hanesii1.htm.
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New Horizons in Health: An Integrative Approach designating communities for inclusion in extant longitudinal studies. For example, certain people in the 1946 British birth cohort study who reside in particular settings might be designated for studies of collective community properties that influence the health of individuals. Additional people from such settings might also be enrolled in subsequent waves of the larger study. Shifting to the United States, multiple satellite studies of the National Survey of Midlife Development in the United States 4 might serve as core populations for future biobehavioral research initiatives. Similarly, the Chicago Neighborhood Study might be a critical resource for the broad-gauged investigations of pathways described herein. These specific studies are mentioned here only to illustrate the kinds of possibilities that need to be addressed. Indeed, broad consideration of communities in the United States and other countries should be part of the process of identifying the minimal set of populations to be maintained for the integrative studies delineated in this report. Turning to animal populations, the free-ranging monkeys at Cayo Santiago Island (Berard, 1989) and Amboseli baboon communities (Altmann et al., 1993) are two instances of nonhuman primate communities that would be central resources for investigating the maintenance of allostasis, the cascade of events leading to allostatic load, and biopsychosocial pathways to diverse health outcomes. Laboratory colonies are also needed. Much more naturalistic living conditions than are currently operative—where ongoing interaction among multiple animals is facilitated —will be necessary for studies of pathway and environmentally induced gene expression delineated in Chapter 4. CLINICAL RESEARCH CENTERS Most major academic medical centers have a general clinical research center (GCRC) as part of their research infrastructure. The objective of these centers is to facilitate clinical studies on human populations. The emphasis, historically, in these centers has been strictly biomedical. Recently there has been encouragement for GCRC studies that integrate social and behavioral science and biomedical assessments on the same population. A prototype can be found in the GCRC at the University of Wisconsin (Ryff, 2000). A key project leading to renewed funding for that center focused on how social relationships are consequential for health. The study emerged from the growing body of research in social epidemiology, which 4 The data are available electronically: National Survey of Midlife Development in the United States: http://www.pop.psu.edu/data-archive/daman/midus.html [11/27/00].
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New Horizons in Health: An Integrative Approach shows that those who are more socially integrated have lower profiles of disease and tend to live longer (see Chapter 5). What is poorly understood, however, is how the life-enhancing benefits of quality relationships come about. Significant others may encourage the practice of healthy behaviors, but additional influence may follow from the emotional dynamics of key relationships and how they affect underlying physiological processes. The latter mechanisms are the focus of a multidisciplinary project currently in progress at the Wisconsin GCRC. The purpose of the work, broadly defined, is to probe linkages between psychological, social, and emotional well-being and multiple aspects of biology, including allostatic load, affective neuroscience, and immune function. It is part of the larger program of characterizing predisease pathways (see Chapter 2) and pathways to positive health outcomes (see Chapter 3). From the perspective of this report, strong bridges between community studies focusing on predisease pathways or resilience, for example, and biomedical assessments on the same population could be carried out effectively through collaborative studies with GCRCs. Ambulatory blood pressure studies with simultaneous assessment of environmental influences (Schnall et al., 1998; Pickering et al., 1996; James et al., 1991) are important prototypes for more expansive investigations linking psychosocial and biological processes. This provides a major avenue to integrate social and behavioral sciences with biology and clinical medicine, thereby fostering symbiotic relationships and greatly enriched research programs between GCRCs and the social sciences. COMMUNITIES AND INTERVENTIONS Health promotion and primary disease prevention intervention programs are frequently centered around communities. Thus, the selection of communities for the core population infrastructure should partially be guided by the nature of the opportunities to assess the impact of currently operative interventions as well as for implementing new ones. We also view intervention programs as opportunities to advance understanding of more basic scientific questions. For example, a program designed to enhance a sense of purpose in life among the elderly in a retirement community—with consequential downstream positive health consequences (see Chapter 3)—could be accompanied by biomarker assessments on a subset of the community with the objective of understanding the physiological substrates that underlie an improved sense of purpose in life. This kind of activity would directly improve our understanding of the biological mechanisms associated with positive health at the psychosocial level. It also points to the major opportunity to integrate intervention studies with what are typically viewed as basic research projects.
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New Horizons in Health: An Integrative Approach TRAINING The multidisciplinary nature of all the thematic priorities in this report implies the need for training initiatives to support and sustain careers crossing current disciplinary boundaries. NIH has had some success in initiating and fostering such careers within biomedical disciplines. However, success in the integrative studies central to the mission of this report requires a cadre of scientists who are facile in working across multiple levels of analysis in the social, behavioral, and biomedical sciences. Linking young investigators to ongoing research of this integrative character (e.g., the recently funded mind/body centers) is one approach to developing new generations of such investigators. Training grants awarded to academic centers with a demonstrated track record of integrative research as described in this report would greatly facilitate education in the direction of “consilience” (see Chapter 1). It is of considerable importance to send clear signals that there are career paths, focused on integrative biopsychosocial topics, with promise for novel and valued scientific advancement. RECOMMENDATIONS NIH should provide core support for sustained infrastructure in two areas: longitudinal survey populations, human communities, laboratory animal colonies, and free-ranging animal communities; training initiatives to nurture and regularize the hybrid (multidisciplinary) careers of a new generation of scientists, facile in working across social, behavioral, and biomedical levels of analysis. The vision of research proposed in this report, with its focus on the unfolding interactions between genetic, behavioral, psychosocial, and environmental factors over time and its recurrent emphasis on multilevel analysis, highlights the need for greater cross-institute strategic planning and trans-institute research initiatives. This committee has not been asked and is in no position to make detailed recommendations regarding the structure of NIH. However, the success of an integrative research approach will require collaborative efforts of the entire NIH community of scientists—medical, biological, behavioral, and social. Both incentive structures and an institutional presence will greatly facilitate such collaborative strides. As a first step the committee recommends that NIH create an internal mechanism for developing consensus on the most promising research opportunities within and across the thematic priorities, as well as a locus for strategic planning for future trans-institute initiatives.
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New Horizons in Health: An Integrative Approach REFERENCES Altmann J , Schoeller D , Altmann S , Muruthi P , Sapolsky R. 1993 “Body size and fatness of free-living baboons reflect food availability and activity levels” American Journal of Primatology 30 : 149-161 . Berard JD. 1989 “A four-year study of the association between male dominance rank, residency status and reproductive activity in rhesus macaques (macaca mulatta)” Primates40 : 163-178 . Berkman LF , Breslow L. 1983 Health and Ways of Living: The Alameda County Study ( New York : Oxford University Press ). Dawber T. 1980 The Framingham Study ( Cambridge MA : Harvard University Press ). Hauser RM , Carr D , Hauser T , Hayes J , Krecker M , Hsiang-Hui DK , Magee W , Presti J , Shinberg D , Sweeney M , Thompson-Colon T , Uhrig SCN , Warren JR. 1993 The Class of 1957 After 35 Years: Overview and Preliminary Findings James GD , Moucha OP , Pickering TG. 1991 “The normal hourly variation of blood pressure in women: Average patterns and the effect of work strain” Journal of Human Hypertension 5 : 505-509 . National Institute on Aging . 1991 Research on Older Women and Highlights from the Baltimore Longitudinal Study of Aging ( Bethesda MD : U.S. Department of Health and Human Services ). Pickering TG , Devereux RB , James GD , Gerin W , Landsbergis P , Schnall PL , Schwartz JE. 1996 “Environmental influences on blood pressure and the role of job strain ” Journal of Hypertension 14/suppl.J : . Power C , Matthews S. 1998 “Accumulation of health risks across social groups in a national longitudinal study” in Strickland SS , Shetty PS (eds.). Human Biology and Social Inequality ( Cambridge U.K. : Cambridge University Press ) 36-57 . Russek LG , Schwartz GE. 1997 “Feelings of parental caring predict health status in midlife: A 35-year follow-up of the Harvard Mastery of Stress Study” Journal of Behavioral Medicine 20 : 1-13 . Ryff CD. 2000 “How are social relationships consequential for health?” The Link , a publication of the University of Wisconsin-Madison General Clinical Research Center 4 : 1-2 . Sampson RJ , Raudenbush SW , Earls F. 1997 “Neighborhoods and violent crime: A multilevel study of collective efficacy” Science 227/5328 : 918-924 . Schnall PL , Schwartz JE , Landsbergis PA , Warren K , Pickering TG. 1998 “A longitudinal study of job strain and ambulatory blood pressure: Results from a three-year followup” Psychosomatic Medicine 60/6 : 697-706 . Wadsworth MEJ , Kuh DJL. 1997 “Childhood influences on adult health: A review of recent work from the British 1946 national birth cohort study, the MRC National Survey of Health and Development” Pediatric Perinatal Epidemiology .
Representative terms from entire chapter: