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COST OF LONG TERM PLAN

Mr. Natcher: How much funding do you estimate will be spent to develop the long term research plan?

Dr. Hoel: Based on historical analysis of costs associated with the development of prior long term research plans, we have budgeted $253,000 for this activity.

RESEARCH MANAGEMENT AND SUPPORT

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Mr. Natcher: Other than the evaluation set-aside, what accounts for the 16.8 percent increase in 1992 RMS costs?

Dr. Hoel: The evaluation set-aside accounted for 11.8 percent of the increase and the remaining 5 percent will cover built-in increases and one additional FTE.

LENGTH OF ACADEMIC AWARDS

Mr. Natcher: What is the average length of the Environmental/ Occupational Medicine Academic awards initiated in 1991?

Dr. Hoel: Successful candidates selected for Environmental/Occupational Medicine Academic Awards are provided with 5 years of support.

NEW FACILITY

Mr. Natcher: How could the costs of the two wings at the Research Triangle facility be spread over a multi-year period?

Dr. Hoel: There are several possibilities for multi-year funding. One scenario would be to do all of the preliminary site and utility work and provide the lab building shell in FY 1992 at a cost of $17.9 million and then finish the lab module in FY 1993 for $29.8 million. The office module would be done in FY 1994 for $15.5 million. Spreading the costs would increase the total from $55.3 million due to inflation and other inefficiencies but would be workable.

TRAINING PROGRAMS

Mr. Stokes: What amount and percentage of your extramural and intramural funds are directed toward training minority researchers and doctors?

Dr. Hoel: In FY 1990, we devoted $264,000 to the NIH Minority Supplements Program and $139,000 to the Minority Access to Research Careers program through co-funding with NIGMS. This represents 0.42% of the NIEHS extramural grant funds. Through continued vigilance in identifying minority researchers and doctors, we anticipate that we will devote at least this percentage of the NIEHS' extramural funds for these purposes in FY 1991 and FY 1992. In our intramural program, about $300 thousand or 0.43% is devoted to outreach programs.

Mr. Stokes: In the intramural activity $70.3 million is being requested for research, a $2.7 million increase. How many researchers from disadvantaged minority groups are employed in this area? Please provide a breakdown by grade and ses levels.

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In addition to the scientists listed, we have 87 minority employees in the Intramural activity who provide support to our researchers.

Mr. Stokes: The National Research Award Program supports training of scientists for careers in basic and applied research in reference to the human health implications of environmental exposures. How many grants and fellowships are proposed for this program in FY 1991 and FY 1992?

Dr. Hoel: The FY 1991 budget includes funds to support 38 individual fellowship awards and 417 full-time training positions on 41 institutional

training grants. The FY 1992 budget includes training funds to support a siailar number of trainees as the FY 1991 budget.

Mr. Stokes; What amount and percentage of these awards went to minority researchers?

Dr. Hoel: While it is impossible to ascertain all the support going to minorities from information contained in the grant applications, I can tell you that in FY 1990 NIEHS did provide $139,000 through NIGMS for the support of the Minority Access to Research Careers program. This is 1.3% of our total training grant program.

Mr. Stokes: Last year, NIEHS initiated a summer outreach program involving science faculty from the NIH extramural associates universities and colleges. This pilot program was designed to enhance opportunities in the laboratories of some of the Institute's most prominent scientists. will the progran be continued in FY 1992 and what level of funding has been requested?

Dr. Hoel: The Summer Program for college faculty, high school teachers, and students with various educational backgrounds is an ongoing effort that will definitely be continued in FY 1992. The estimated cost for this effort in the coming year is $250,000-300,000.

LEAD

Mr. Stokes: As you know Doctor, an alarning number of children are being exposed to lead. Research programs conducted and supported by NIEHS have resulted in new findings in reference to the characterization of the relationship between iron deficiency and lead absorption. To what degree does proper nutrition ameliorate developmental and other problems associated with lead poisoning?

Dr. Hoel: There are both direct and indirect effects of proper diet on lead effects in all stages of life, but especially early life. Among the direct effects are the roles of dietary iron, calcium, and possibly protein on the absorption of ingested lead, whether this lead comes from air, food, or water. As already mentioned, iron and lead compete for the same absorption systems, and persons with insufficient iron intakes, or suffering iron deficiencies, will absorb extra amounts of any lead ingested. Similarly inadequate intake of calcium and possibly of protein may result in increased lead absorption.

Indirect effects of diet result from the interactions of these and probably other nutritional components and lead in tissues where metal action/toxicity occurs. Not only do these diet components affect how much lead is taken up, for example, in the intestine, but at the places where lead is highly toxic such as brain, kidney, and reproductive organs, there is another competition between lead and calcium, iron, and so forth, for sites which govern functions in these tissues. Again, if the body does not have optimal amounts of iron or calciun and probably proteins, the absorbed lead is more likely to damage these sensitive sites.

Diet deficiencies at particular times in life, for example, pregnancy/fetus, and early childhood, can be especially critical and likely to be associated with long-lasting, if not permanent, lead toxicity. Proper nutrition for the pregnant woman is critical for the future of her unborn child--but especially in terms of the effects of lead on that child.

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We do not know enough about the effects of optimal nutrition on developmental and other problems associated with lead poisoning. Among the things we need to know a lot more about are whether more vitamins, calcium, and very high quality protein can have even better protective effects against lead toxicity than just sufficient levels of these factors. We also need to know more about what roles vitamins might play in lead toxicities and vice

We also need to know when diet supplements are most effective/ critical.- is this even before conception for example? And how about early versus late childhood--will better diets help even those having body burdens of lead already, even those who are now in their teens? We have uncovered the tip of an iceberg here, and need to know a lot more about what lies below the surface. This is particularly true since it is likely that dietary interventions will be by far the cheapest, quickest and most effective of interventions in minimizing lead toxicity and damage to children both unborn and now alive.

Mr. Stokes: Are efforts underway to use nutrition and diet as a means of treating lead poisoning?

Dr. Hoel: Limited studies, primarily in animals, have indicated that better nutrition is very effective in lowering the proportion of any ingested lead which is absorbed and probably any excreted lead which can be reabsorbed. Certainly the present, but other-directed governmental supports for better child nutrition, for example, the Women, Infants and Children program, could be helping here. However, deliberate diet interventions to treat lead poisoning are not being pushed as hard as they should be.

This could be a very fruitful area of research since presently available drug treatments for lead poisoning are not entirely safe for children and can be relatively ineffective for lower ranges of lead poisonings persons --with blood lead concentrations below 25 micrograms per deciliter.

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Mr. Stokes: The incidence of lead poisoning is particularly high among minority children. What are some of the recent findings NIEHS has made in this area?

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Dr. Hoel: A number of our grantees, including teams at Pittsburgh, Boston, and Cincinnati are looking at populations of children who have been exposed to varying amounts of lead and have different blood lead concentrations. These populations are being followed for extended periods of time to see how different degrees of lead poisoning affect development, learning, behavior, and so forth, over a range of childhood ages. In most of these populations, the most severe lead effects and lead poisonings are being documented among inner city children and most of those affected most severely have been minorities. We reported on some of these findings last year at these hearings.

The most unsettling of these new results suggest that very low concentrations of lead below the present, generally accepted "action" levels of 25 micrograms lead per deciliter of blood, can still cause behavior and IQ decrements, and that some of the effects of lead on behavior and development night be permanent. NIEHS is continuing to support these studies to see if these adverse effects identified as resulting from early childhood exposures to lead persist into adulthood and, if so, to what ages. We also want to see if these results suggesting permanence of lead effects, now seen in one population of immediately post high school children, are seen in other populations under study in different grants.

THE ENVIRONMENT AND MINORITY HEALTH

Mr. Stokes: Blacks suffer from a disproportionately high rate of disease compared to whites. A comprehensive report on this was prepared in 1985 by Secretary Heckler. Some suggest that many of the health problems experienced by blacks is the result of the lack of environmental equity. They contend that blacks are exposed to greater risks as a result of the location of hazardous waste sites in their communities, working conditions in industry, air pollution and many other conditions. What level of resources are being used by NIEHS in support of research in this area?

Dr. Hoel: We have carefully analyzed our entire research program at NIEHS to determine the level of our resources that are directly related to the study of the health effects of environmental agents on the health of citizens from minority and other disadvantaged groups of American citizens. According to this analysis, almost $8 million is directed to research on minorities. The analysis was revealing in several respects. NIEHS does almost no clinical research, but in contrast, conducts a vast amount of toxicological research to identify environmental hazards and laboratory research to determine the mechanisms by which hazardous environmental agents cause diseases and disabilities. This latter research does ot directly involve humans and thus cannot be classified as minority health research. However, our toxicologic studies and our basic research is highly relevant to the health of minority citizens. NIEHS pesticides studies are concerned with potential hazards to rural families who draw their drinking water from wells and migrant laborers and their families who are at high risk of direct exposure to agricultural chemicals such as fertilizers, herbicides, pesticides, and fumigants. Our air studies are directed to such substances as ozone and acid aerosols which concentrate in urban inner-city neighborhoods where many poor minority citizens live. Our studies of hazardous nan-made chemicals result in reductions in occupational exposures which affect the most hazardous and lowest wage jobs which are often held by minorities. Similarly, releases of toxic substances from transportation spills and industrial accidents generally occur along major highways and railways which generally traverse poorer neighborhoods. It is our estimate that as much as half of our research is directly relevant to the environmental health of minority Americans.

Mr. Stokes: area?

Is there a need for more comprehensive research in this

Dr. Hoel: Yes. NIEHS has made a number of suggestions for better and more complete studies of this problem in a number of different forums.

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