This information is critical to the effective care of infant's oxygen level. A third study addresses risk-taking behavior among adolescents. These behaviors are being examined among 1500 young people in grades eight through twelve in four rural Maryland counties. Personality characteristics, family backgrounds, and social interactions of those who engage in risky behaviors are being compared with those who do not. Initial data indicate surprisingly high levels of risk-taking behavior, such as drinking, speeding, and sexual activity at very early ages in this group of essentially middle-class adolescents. Preliminary analyses also show ethnic and gender differences in these behaviors. This study should provide important direction for fostering health-promoting behaviors in young people. For future scientific opportunities, NCNR will focus heavily on healthpromotion and disease-prevention issues at each stage in the life span. Many health problems are in large part behaviorally determined and can be prevented or significantly improved through changes in behavior. The incidence of low birthweight, which accounts for nearly two-thirds of the 45,000 infants who die each year in the United States, can be considerably reduced through changes in maternal behaviors and lifestyle. One of the most significant factors in pregnancy outcomes is the expectant mother's social support system and its influence on her maternal behavior. An NCNR investigator is determining sources of positive support for low-income black women with input from members of the black community--nurse midwives, community workers, and pregnant women. The objective of this study is to design a culturally sensitive support intervention for these women, one that includes acceptable substitutes when their mothers or partners are not available. Children of racial and ethnic minorities and those of lower socioeconomic status are especially vulnerable to adopting early risk behaviors that lead to diseases in later life. Three interventions to reduce cardiovascular risk factors are being compared in a group of 1600 rural and urban children. The interventions are (1) a large-scale information program to be taught in the classroom, (2) an individualized program to be provided by nurses for at-risk children, and (3) provision only of baseline screening results and their implications in a control group. Results of this study will help to delineate the role of nurses in individualized and population-based interventions for school-aged children aimed at reducing high risk behavior. More attention must be paid to health issues at midlife, especially for women. Changes in gut function, menopausal symptoms, sleep disturbances, the stress of multiple roles resulting from careers and responsibilities for both children and aging parents--all require intensive research to improve the health and well-being of this age group. In one study, more than 450 women aged 35 to 55, including ethnic minorities and those with low-income lifestyles, will be tracked over a three-year period. The objectives are to determine demands made upon these women and their resources (including their health), specific stressors, attitudes about their multiple roles, and the steps they take to promote and maintain their health. This information will help determine the specific nursing interventions necessary to promote and maintain optimal health in this age group. of independence. Deficits in mobility, strength, balance, and endurance can pose serious physical problems for older people and increase their risk of injury and loss Among elderly nursing home residents, falls account for the major portion of reported injuries. Many of those who sustain hip fractures die from complications within a few months. The National Center for Nursing Research and the National Institute on Aging are cosponsoring "Frailty and Injuries: Cooperative Studies of Intervention Techniques" (the FICSIT project). This project involves an innovative mix of exercise, nursing, and rehabilitation techniques designed to reduce the loss of functional capacities and fall-related injuries in older persons. The NCNR component of the FICSIT project focuses on determining the benefit obtained from assisting high-risk nursing home residents to and from the toilet and the effectiveness of hip protective garments in reducing injuries from falls. Hypertension continues to be a serious problem among the black population, where the incidence is higher, the rate of control lower, and the likelihood of complications greater. One grantee is utilizing the resources of black churches for educational programs for members of their congregations who have high blood pressure. Nurse members are trained to educate people with hypertension about the meaning and management of their illness. The NCNR's long-term care initiative focuses on nursing interventions for clinical conditions associated with the need for long-term care among people aged 65 and over. Such conditions include, among others, oxygen deficit associated with chronic respiratory disease, impaired mobility, urinary incontinence, and cognitive dysfunction. The Nursing Center supports several studies concerned with interventions for these conditions. An NCNR grantee is investigating the effective delivery of supplemental oxygen to patients who require continuous oxygen therapy from a portable oxygen device. In this study, comparisons among three methods for providing supplemental oxygen are based on measures obtained during exercise performed at home. Early findings indicate that oxygen delivery through a tube in the neck is clearly better than through a nasal tube. These findings have important implications for management of respiratory conditions. Another study is underway to determine the effect of a family-based intervention on the cognitive stimulation of patients with Alzheimer's disease. Effects on the well-being of their caregivers and caregiver-patient interactions are also being observed. A technique to provide cognitive stimulation is being taught to caregivers, who then use the technique with their patients every day at home. Preliminary data show trends toward improvement or maintenance in the treatment group and decreased cognitive functioning in the control group. Other early results indicate a trend toward improved family interaction in the experimental caregiver group. As numbers of rural residents of the United States have become proportionately smaller, their vulnerability to illness, disability, and poor pregnancy outcomes has increased. Research is needed to determine the health status of these individuals, their health-care requirements, and effective methods of delivering health care to them. NCNR is supporting two projects in a special initiative to study health care needs in rural and minority populations. One is designed to improve birth outcomes through improved prenatal care to Native Americans and Hispanics living in rural communities in Oregon. The other is evaluating interventions for providing prenatal care to Hawaiian, Filipino, and Japanese women living in a rural district of Hawaii. These projects are intended to provide models of culturally sensitive, affordable, and cost-effective prenatal care for minority women in rural communities. With its focus on vulnerable populations, the rural health initiative is also a valuable means of addressing minority health issues. In the area of women's health, the NCNR supports a broad range of studies, including investigations of predictors of pregnancy complications for women of lower socioeconomic status, factors that influence women's decisions about estrogen replacement therapy, recovery in older women after hip fractures and heart attacks, and attitudes toward breast cancer, breast selfexamination practices, and mammography. In addition, the NCNR supports a Center for Women's Health Research at the University of Washington for the study of women's health concerns across the life span. The NCNR is continuing to oversee the development of its major long-range planning initiative, the National Nursing Research Agenda. Two priority areas of this Research Agenda have been implemented as planned for fiscal years 1990 and 1991. The current focus of research in the first area, HIV Infection: Prevention and Care, is the management of symptoms at various stages of the disease. In addition, the Nursing Center's Collaborative Intramural Research Program is conducting a study of the type, severity, and causes of nutritionrelated symptoms and problems in individuals with HIV infection, such as unintentional weight loss and decreased appetite. Mothers and In the second area to be implemented, Low Birthweight: Infants, current program emphasis is two-fold: (1) the prevention of low birthweight through attention to maternal factors and (2) the special care requirements of the low-birthweight infant. Of the remaining research agenda areas, Long-Term Care for Older Adults and Symptom Management are in the final phases of development for program initiation in fiscal years 1991 and 1992. The areas of Health Promotion: Children and Adolescents and Technology Dependency Across the Lifespan are just beginning to be developed. Research training continues to be the focus of major program development. In order to further enhance nursing research, the NCNR is striving to develop a strong cadre of well-prepared nurse investigators. Special emphasis has been placed on increasing the number of trainees, building postdoctoral programs, and supporting more research intensive environments for training and career development. Increasing the numbers of our minority colleagues in the research arena also remains a major priority of the Nursing Center. Several strategies have been employed, including special supplemental awards to increase the numbers of minority investigators in ongoing research and to provide additional training opportunities. The number of minority investigators in research training has increased substantially over the past four years. Mr. Chairman, the FY 1992 budget request for this Center is $43,747,000. I will be pleased to answer any questions that you may have. BIOGRAPHICAL SKETCH OF DR. ADA SUE HINSHAW May 20, 1939. Arkansas City, Kansas. Education: B.S., University of Kansas, Lawrence, Kansas, 1961; Professional History: 1963-1965, Instructor and Chairperson, Professional Organizations: American Academy of Nursing, Honors Awards: Kay Schilter Award, University of Kansas School |