Program. Are there any unmet needs? If so, what are the funding requirements.

Answer. Because of the impact of AIDS on minority populations RCMI grantee institutions will participate in AIDS research in FY 1992. The collaborative effort between the NIAID and the RCMI will continue.

Question. Last year concerns were raised about the inclusion of minority institutions in the Human Genome Initiative. Is there a written progress report and an implementation timetable available?

Answer. In July 1990, the Association of Minority Health Professions Schools (AMHPS), the RCMI Program, Meharry Medical College and the National Center for Human Genome Research (NCHGR) organized a Planning Meeting for Participation in the Human Genome Initiative. The purpose of the meeting was to provide a forum for information sharing and interaction among RCMI investigators and scientists supported by the NCHGR, and with NCHGR staff, in order to facilitate understanding of how involvement by RCMI institutions could be maximized.

The conference proceedings are not yet finalized. Several investigators from the RCMI research community are developing grant applications for this initiative. Five faculty at RCMI grantee institutions will attend and participate in the June 1991 NCHGR grantees workshop on physical mapping. Additionally, the NCHGR has encouraged faculty at RCMI grantee institutions to participate in short courses, such as those at Bar Harbor or Cold Spring Harbor, that will enable the faculty to stay abreast of the field.

MINORITY CONSTRUCTION

Question. Fifteen million dollars are earmarked for construction in Historical Black Colleges and Universities and similar institutions in the 1992 president's budget request. There are over 100 Historical Black Colleges and Universities. If we assume that there are at least another 50 institutions which would qualify, to what extent can an average of $100,000/institution develop state-of-the-art biomedical research facilities at these institutions? Should the scope of construction dollars be limited to those minority institutions that have faculty research as a mandate?

Answer. NCRR anticipates awarding grants to only a few HBCUs and similar institutions which submit applications. The Research Facilities Improvement program would make awards of up to $1,000,000, and applications would be peer reviewed. In order to receive funds, institutions must demonstrate existing research capability. Consideration will be given to the amount of non-Federal funds that applicant institutions have secured to match NCRR funds.

COORDINATION OF MINORITY PROGRAMS

Question. The NIGMS has established a senior level position in order to more effectively plan and meet the emerging needs of the minority community through its existing or anticipated program. Since the NCRR's 1992 portfolio includes a number of activities that impact on the minority community (RCMI, construction for minority institutions, Minority High School Apprenticeship Program, and the Minority Clinical Associate Physicians Program), do you envision a similar administrative structure within your organization?

Answer. The minority programs of the NCRR are very different in their mission, scope, recipient communities and mechanisms of support. Because of these differences, each of the programs is under the management of a separate program director. Each of the Program Directors reports to the Deputy Director for Extramural Research Resources who coordinates them. By having direct access to the top level of management of the Center, the program directors of the various activities are able to maximize the potential for each program without the need for an additional layer of management.

BIOMEDICAL RESEARCH SUPPORT GRANTS

Question. Since the 1992 president's budget request has zeroed out the BRSG Program, are there contingency plans such as reprogramming funds to meet this need?

Answer. There are no plans to reprogram funds into the

BRSG Program at this time.

NATIONAL CENTER FOR NURSING RESEARCH

STATEMENT OF DR. ADA SUE HINSHAW, DIRECTOR

BUDGET REQUEST

Senator HARKIN. Dr. Hinshaw, the committee is pleased to have you with us again today to represent the National Center for Nursing Research.

Your budget request is for $43.7 million, which is $4 million or 10 percent more than last year. The first funding provided for the nursing center was $20 million in 1987. The budget has more than doubled since then. The number of research project grant applications reviewed for the center has also more than doubled from 160 in 1987 to an estimated 354 for 1991.

Dr. Hinshaw, I would be pleased to hear your statement at this time. Please proceed.

Dr. HINSHAW. Thank you, Senator. It is an honor to appear before you again to discuss the programs of the National Center for Nursing Research, the current state of knowledge for nursing practice, and the challenges that are facing us in terms of patient care. In its fifth year, the NCNR has shown substantial progress in the establishment of productive programs of research and training, in important preliminary findings achieved by our grantees, and also in continued planning for growth and expansion. Clusters of studies are now being assembled in areas central to nursing practice, such as prevention and care of low birthweight infants, symptom assessment and management, long-term care of older individuals, and health promotion across many aspects of the lifespan.

NATIONAL NURSING RESEARCH AGENDA

Four program areas are being proposed for a major development in 1992. First, long-term care requirements of older persons, a priority of the National Nursing Research Agenda, will stress nursing interventions and strategies that facilitate the maintenance of sound health and increase the older person's ability to maintain a high degree of well-being and to maintain themselves in the community rather than a nursing facility. The second area for major development is symptom management. Our research will initially focus on acute pain assessment and management in vulnerable populations. Acute pain is one of the four symptoms identified in the National Nursing Research Agenda. Interest in this area of research is shared with other NIH components, and we are seeking opportunities for collaboration.

The third area of expansion will involve the intramural program. Growth will be in the area of health-related quality of life. It is an initiative of high priority for us. Intramural scientists will develop

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methodologies for the comprehensive study and evaluation of health-related quality of life.

The intramural program also conducts research on symptoms and side effects of treatments faced by individuals with HIV infection. Examples include muscle wasting, compliance issues, nausea, and fatigue.

The fourth area of expansion, health promotion among children and adolescents, is also a designated priority of the National Nursing Research Agenda. This will address dominant, preventable health problems in emerging lifestyles related to diet, physical activity, alcohol and smoking, and sexual behavior to achieve healthpromoting behavior changes in children and adolescents. We judge that if we would intervene at an earlier age, one might have a better opportunity to achieve health-promoting behaviors. We know how difficult it is at our age to try to maintain diets or to quit smoking. It would be better to start very early in life as lifestyles are emerging, to achieve these health-promoting behaviors.

Other areas of research are currently undergoing substantial program development. They include nursing interventions and women's health. In this area we stress midlife health issues and longitudinal studies of health and disease across the context of a woman's life.

An initiative on low birthweight has resulted in a cluster of studies. This will continue to be expanded. About 9 percent of our portfolio is currently in this area of study. This initiative targets studies that look both at care of the premature infant within the neonatal ICU's and studies which provide prenatal care in the community in a culturally sensitive way. I would be glad to speak to several of those studies later if you would like.

Rural health is another major focus for us, thanks to the directive and the encouragement of the Senate from the last 2 years. In addition, two task forces are being established which will advise us on policies regarding native American health care issues and on the issues of rural health.

PREPARED STATEMENT

I was also interested in the earlier points that you made about research training, because as a rapidly growing research discipline, a strong emphasis has been placed on establishing a cadre of wellprepared nurse investigators. Approximately 11 percent of our budget is invested in nurse research training, which is comparable to about 4 percent that is invested by NIH overall in biomedical research training. We have placed extra emphasis and dollars in order to expand the cadre of well-prepared nurse investigators. We are building post-doctoral programs supporting research intensive environments for training, and also creating training opportunities for our minority colleagues.

The fiscal year 1992 budget request for the National Center for Nursing Research is $43,747,000.

I would be pleased to answer any questions that you may have. [The statement follows:]