for behavioral research personnel can be assessed, they represent but one of the several dimensions of “needs.” Cognizant of the important advances in behavioral research that promise to enhance the health and well-being of all citizens and confident that NRSA awardees will have the opportunity to contribute to the national health effort, the committee has concluded that the present modest program of NRSA support in the behavioral sciences should essentially double in the next few years. However, because of our concern with current low levels of stipend support, we have adjusted our goals to permit immediate expansion of training stipends throughout the NRSA program. We believe, however, that the national call for skilled behavioral science investigators should be answered swiftly and strongly through an increase in training support in this area.
The knowledge base in the behavioral sciences has reached the point where effective utilization of its findings by physicians, clinical psychologists, nurses, and social workers can have a very significant impact on health-related problems in our society. Advances in basic research in behavioral science dovetail well with national needs.
This is a most exciting and intellectually stimulating time in behavioral science. Work on both basic and applied problems—and work done at many levels of analysis, from brain-behavior relations to the study of disease processes in human populations—is making great progress. We cite three examples in more detail to illustrate the intellectual excitement in the field.
Much of the social and behavioral research supported by the National Institutes of Health represents research on “health and behavior”. Current estimates place NIH support for research in this area at about 8 percent of total NIH R&D support (COSSA, 1994). The “NIH Implementation Plan for Health and Behavior Research ” (NIH, 1993) outlines, furthermore, what the Institutes and Centers consider to be optimal spending levels in this area during the next 5 to 10 years.
Expanded support for research on health and behavior reflects an increasing recognition by the health research community that social and psychological factors play a significant role in the natural history of disease, prevention of disability and illness, and promotion of recovery. As the Director of NIH stated in a 1991 report on the same subject (NIH, 1991):
Our research is teaching us that many common diseases can be prevented, and others can be postponed or well-controlled, simply by making positive life style changes. For these reasons, intensifying such research and encouraging all Americans to make health-enhancing behaviors a part of their daily lives has taken on more and more importance in our efforts to conquer disease.
The domain of research on health and behavior is broad and the enormity of its knowledge base is daunting, but as Adler and Matthews (1994) suggest, many of the concepts in recent years pertain to three essential questions:
Who becomes sick and why?
Among the sick, who recovers and why?
How can illness be prevented or recovery promoted?
To facilitate the answers to these and other related questions, the NIH Reauthorization Act of 1993 established the Office of Behavioral and Social Sciences Research and called for a report to the U.S. Congress on the extent to which the Institutes of Health conduct and support research in the component disciplines. Because the Office is still being organized within the National Institutes of Health, Howard Silver and the staff of the Consortium of Social Science Associations (COSSA) recently prepared a detailed, although preliminary, summary illustrating NIH funding priorities in the area of health and behavior. For example, the COSSA summary notes that the National Heart, Lung, and Blood Institute (NHLBI) supports a variety of activities— primarily through the Behavioral Medicine Branch—on disease prevention, etiology, diagnosis and treatment of cardiovascular diseases. The National Institute of Allergy and Infectious Diseases (NIAID), which is concerned increasingly with the transmission of AIDS, supports only a modest amount of social and behavioral research but has expressed interest in psychosocial factors affecting medical treatment of compliance. The National Institute of Environmental Health Sciences, to give another example, supports research on the effects of environmental agents on human health and well-being with particular attention to behavioral and neurological effects of exposure to toxic substances.
Variables that have been explored by research scientists over the years can be categorized in any number of ways, but include research on factors that arise from the social environment which contribute to disease. Such factors include: stress (Cox and Gonder-Frederick, 1992; Beardsley and Goldstein, 1993) or social isolation/social connectedness (Cohen, 1988; Reynolds and Kaplan, 1990). Individual dispositional factors are also thought to contribute to disease onset and recovery, such as: hostility/Type A personality (Siegrist et al, 1990; Matthews et al, 1992); depression/ exhaustion (Hahn and Pettiti, 1988; Markovitz et al, 1991); neuroticism and negative affect (Costa and McCrae, 1987; Salovey and Birnbaum, 1989); and optimism/self-esteem (Schreier and Carver, 1992; Brown and McGill, 1989).