SIST. It is my understanding that ASSIST grants for years were much higher than IMPACT grants, the National Cancer Institute initiated those grants. They were to help anti-smoking efforts, among youth through community-based efforts and education-based efforts. After the ASSIST grant started in 17 states, the other 33 states wanted a similar effort. While it wasn't equal to the ASSIST program, but the IMPACT grants were started Last year we transferred ASSIST grants to CDC and it is my understanding that all we are doing now is increasing the IMPACT grants up to the same level as ASSIST. No state has both programs; isn't that right?

Dr. KOPLAN. You have described it perfectly.

Mrs. NORTHUP. And in fact the 33 states that had the IMPACT grants really had minimal amounts of funding for their anti-smoking efforts that were grassroots previously. So it is not as though we are combining and missing an efficiency here but we are equalizing the grants. Haven't we also extended these to our territories? Puerto Rico and the other territories?

Dr. KOPLAN. We have in the District of Columbia. I am not sure about Puerto Rico and the territories.

Mrs. NORTHUP. I think actually we have.

Dr. KOPLAN. I always learn something here.

Mrs. NORTHUP. In looking at your budget here

Mr. DICKEY. Dr. Northup.

Mrs. NORTHUP. I have appreciated your work. I just want to bring to the committee's attention that almost any time we have the debate on how to deal with tobacco, the tobacco companies, the tobacco industries themselves say we should approach this through education, through a community basis as opposed to taxes. So I would think this sort of activity on your part would be the one area that would unify us all, since it reflects what the tobacco companies and the health community believe is good for decreasing tobacco use among our youth. I just thought I would clarify that.

PEER REVIEW OF RESEARCH

I have a couple of questions about research in particular. I think I raised some of these questions last year but I will raise them again to you. I have been so impressed with the research standards that NIH uses. The peer review on all research that is done before the grants are awarded, after the grants are awarded, the results that are obtained. Quite honestly, I have had some experience in research that wasn't peer reviewed, it is not that the peer review catches mistakes as much as to ensure that the right results and the right conclusions are arrived at as it is done. If any entity would always use the same group and they know what they want the answers to be, they might tend to emphasize those answers unless they know that their fellow scientists are reviewed. And I just wondered how you would compare your quality standards and peer review, both in the awarding process and in the analysis after the fact would compare to NIH.

Dr. KOPLAN. I think our quality standards are superb. We have two types of research, both done within our institution by researchers that is crucial to our public health responsibilities, and then we have a smaller amount of extramural research. We have some leaders in that. The National Institute for Occupational Safety and

Health has decades of experience in funding outside investigators. It is one of its major missions and it does it through, just as you have described, high standard peer review, selection of those researchers, and monitoring of the research as it goes along. In some of our other programs we are only beginning to get some funding for external research. The committee was very generous last year in giving us some funds for prevention research and we are trying to implement in that program the exact same standards that you have indicated for peer review selection of programs.

It is a little different in public health than in biomedical research because some of the groups that do the research aren't pure longstanding academic researchers. In some cases our research is done with state health departments with local health departments so it is not going to be one for one fit of what we do and, say, what the National Institutes of Health does, but nevertheless our intent and our current performance is at a very high level of both quality and integrity in what we do.

Mrs. NORTHUP. I certainly understand that you all have a role in surveying and monitoring and that that wouldn't be the same as research, scientific research, but the research on disease and so forth. I think that that is extremely important. If we operate based on scientific conclusions that are inadequate, or inaccurate I should say, obviously we could go in the wrong direction. So I would encourage you to make sure that those that we work on that, to that goal all the time.

VIOLENCE IN SCHOOLS

I wanted to ask you about your efforts in safety in our schools. I know that there is the violence against women program, and I wondered if any of those efforts would be directed towards young women in schools. In Kentucky we had a shooting that occurred. In Arkansas another shooting occurred. But I think there are also less dramatic and less reported incidents of young women who deal with violence who may be less prepared and less able to exercise self-protection, effect self-protection measures and I just wondered what your efforts were in those areas.

Dr. KOPLAN. Thank you for your question. It is an interesting and important area. We have got a lot of activities going on in that. We have got collaborative efforts with the Department of Education and the Office of Juvenile Justice and Delinquency looking at interventions and monitoring the problem, documenting how much the problem is there. A key thing we are trying to do, I think, is support researchers in determining what are effective interventions to lower the response to conflict as being a violent one. And we have had some very successful approaches to that, working with schoolchildren of different ages to show them alternative approaches to conflict resolution in school which affects young women, young men in different ways so that there is a lot of active work going on there.

Mrs. NORTHUP. That was my time I suppose.

Mr. PORTER. I am afraid it was. Thank you, Mrs. Northup. Mrs. Lowey.

Mrs. LOWEY. Thank you, Mr. Chairman. I want to apologize, Dr. Koplan for being late. Many of us divide our time between two

committees, but I thank you for the very important work you are doing I missed the conversation about obesity but there has been bipartisan discussions on this committee on teen obesity, and its link to teen pregnancy and domestic violence and if we understand it better, then we could make a huge dent in health problems in this area.

I hope somehow that we could constructively work together and have some progress in that area and I thank you for all the work you are doing.

COLORECTAL CANCER

Dr. Koplan, as you know, an estimated 55,000 Americans die from colorectal cancer each year. The good news is when detected early, this cancer can be treated successfully. And I have been very impressed with the CDC's national colorectal screening public awareness program. Can you give us your assessment on how the campaign is progressing and what plans CDC has to expand its efforts to combat the Nation's number two cancer killer. It is extraordinary to me that we have the tools and we have made progress but not sufficient progress.

Dr. KOPLAN. One aspect of this is we work very closely with the American Cancer Society, who are neighbors of ours in Atlanta and who we can gain extra effect from doing things together on issues such as this, as you indicated, colorectal cancer a huge issue, a major cause of death and major cause of cancer. What we are trying to do is support comprehensive cancer control programs in states which will include breast and cervical, colorectal, other appropriate cancers where we can have a preventative role. Screening is shown to be really effective in this. We have got about 2.5 million to work on it so our role has largely been educational ap-. proaches, encouraging screenings, suggesting efficiencies for states of how to get these programs into place and then lots of partnerships with other players in this.

Mrs. LOWEY. Do you think that the work you do is really getting across barriers? Is it working in high-poverty areas, in areas where there are language barriers? Are we reaching men and women where there are significant barriers?

Dr. KOPLAN. Absolutely. There are. I think that at the moment we are just touching on that and I suspect that those problems still exist and that this is not getting that far into it. There are marked discrepancies by economic status and by racial ethnic status in rates at which people get screened and there are subsequent courses as you have indicated and those do need to be addressed.

LABORATORY STANDARDS

Mrs. LOWEY. Regarding infertility treatment, I was pleased to see your agency's 1996 Assisted Reproductive Technologies Success Rate Report, which was released last week, and I understand you recently published the proposed model standards for the labs and infertility clinics as well. All of us know people who have spent thousands of dollars and desperately want to have children and too often they are not successful. Can you tell the committee when you anticipate that those standards will be made final and when you anticipate being able to certify that voluntary accreditation pro

grams meet those standards? Because I think that is really what's critical. People have to know that when they are paying that money for these services, that wherever they are going will give them a good chance of success.

Dr. KOPLAN. Thank you. The final comments on the proposed standards just came in a couple weeks ago to us. We are putting them together and putting it out as a final-as a formal and final report which lists the standards. Hopefully it will be published in the Federal Register. We have no control over when that is, but we are basically almost there in terms of having the final product that goes to the Federal Register. When that happens, laboratories will have the standards that they have to meet to have a decent product and they are supposed to comply voluntarily with that and be able to list themselves as meeting those standards, and I think that is a very important factor for consumers to consider when they choose a place for those services done.

Mrs. LOWEY. Would there be any evaluation of those clinics? You are saying that the clinics will have to publish the standards.

Dr. KOPLAN. The standards will be published and promulgated. I would think that the clinics would want to indicate that they meet those standards because that will give them credibility over competitors in performing these proceedings.

Mrs. LOWEY. Is there any oversight?

Dr. KOPLAN. There is not oversight.

Mrs. LOWEY. We are making the first step. I would like to continue that discussion.

Dr. KOPLAN. We currently put in over a million dollars of our own discretionary funding into this program to support it because we think it is important, but that is where the funding comes from for keeping this going.

Mrs. LOWEY. I just think back upon the time when a woman would go get a mammography and could not be assured that it was accurate and look what amazing progress we have made in that area. Dr. Kessler certainly led that charge and we have seen tremendous progress. So I just want to keep that in mind as we address this, and I hope we can continue that discussion as well.

ASTHMA

I know there was some discussion about asthma this morning. I was very pleased to see that the President's budget included $68 million to combat asthma. As you know, New York City has the highest asthma rate in the country and the problem is particularly bad among children. I have introduced bipartisan legislation to help us address this by providing for public education, improvements in the response of health departments and local schools and promotion of new federal guidelines on asthma prevention and treatment. Last year CDC reported that the number of asthmatics increased 75 percent between 1980 and 1994. Can you account for any specific set of reasons for such a dramatic increase and can you tell us something about what CDC is doing to address this?

Dr. KOPLAN. We don't have an easy answer as to why there has been this huge increase. It may be contributed to by social factors or environmental factors, but those are easy to say. We don't have an answer yet as to why the increases occurred. But that increase

is profound and marked in a number of different places, including New York City. Amongst the approaches we are trying to take in this is to link with partner agencies, and including health care delivery systems in this, that play a huge role in how people get managed with asthma, but be concerned about the home, the environment and to try to eliminate some of those hazards that may be promoting asthmatic attacks in susceptible people.

Mrs. LOWEY. Have you seen any progress made in actually identifying asthmatics? I just wonder that so many of these cases, especially in the minority area-I see my time is up. We can continue the discussion.

Mr. PORTER. Go ahead and finish.

Mrs. LOWEY. I just wonder if so many of these cases remain unidentified far too long and there isn't enough education, there isn't enough direct action to address that.

Dr. KOPLAN. Mrs. Lowey, I think probably most are identified because it is such a dramatic condition and when-it is not something, you know, you stay home when someone has an acute asthmatic attack, they are in emergency, they are at the doctor and it is usually pretty well diagnosed. I think we have seen a very real increase and probably most are diagnosed.

Mrs. LOWEY. Thank you, Mr. Chairman. Thank you, Dr. Koplan. Mr. PORTER. We will have a second round. We have about 15 minutes. Do you have additional questions you would like to ask, Mrs. Lowey?

Mrs. LOWEY. I don't think so today, Mr. Chairman.

Mr. PORTER. Mr. Dickey, you do. We will divide this roughly in half then, and you and I will ask the questions.

Mr. DICKEY. Dennis wanted to say something. I feel sorry for him.

Mr. WILLIAMS. I just wanted to add one footnote to Mrs. Lowey's discussion on asthma that I wanted to point out to her that in the Health Care Financing Administration budget, there is a new grant program requested, $50 million, to provide resources to states to improve the management of asthma for kids involved in the Medicaid program. So there is some efforts here in the budget to try to deal with this question.

Mrs. LOWEY. Thank you so much I think more resources are needed because the increase is so extraordinary. You just wonder has it been undetected or are living conditions so much worse than they used to be and I really think it is important that we take some direct action. Thank you, Mr. Chairman. Thank you.

FOOD SAFETY

Mr. PORTER. Dr. Koplan, in December the FDA published a final rule to provide for the safe use of ionizing radiation to treat red meat products to control pathogens and extend shelf life. What are you doing to promote this as a method of controlling pathogens and are you finding resistance from consumers?

Dr. KOPLAN. I am not sure we are playing a role in that. I will look into it and try to get back to you with more information on it [The information follows:]