Institute still solid source for behavioral research

Behavioral researchers find a friend in the Heart, Lung and Blood Institute.

By Beth Azar
Monitor staff

Anyone who doesn?t think there?s room for behavioral researchers in the medically oriented world of cardiology, hematology and lung disease should think again.

This year, the National Heart, Lung and Blood Institute (NHLBI) spent nearly $100 million on behavioral research that included everything from epidemiological work?linking disease with factors such as diet, exercise and the environment?to animal studies examining the mechanisms by which social stress causes atherosclerosis. And it published a report detailing exciting new opportunities for behavioral researchers.

There?s never been a better time for behavioral researchers to apply for funding from NHLBI, says psychologist Peter Kaufmann, PhD, leader of the institute?s Behavioral Medicine Scientific Research Group.

'The institute is open to funding behavioral research,' says Kaufmann, who notes that his program has a strong supporter in institute Director Claude Lenfant, MD. 'There?s no bias here.'

In fact, 'the NHLBI, under Lenfant?s leadership, has been extraordinarily supportive of research in our field,' says behavioral medicine psychologist and researcher Stephen Manuck, PhD, of the University of Pittsburgh. 'And it?s because of this support that we can now point to so many significant advances in our understanding of cardiovascular disease?new knowledge that extends from social epidemiology to basic processes of pathobiology.'

Furthermore, Lenfant?s decision to commission the new report on 'Behavioral Research in Cardiovascular, Lung and Blood Health and Disease' indicates that he?s willing to expand the institute?s support of behavioral research even further.

The majority of NHLBI-funded behavioral research is applied and focuses on heart disease rather than lung and blood diseases. However, the institute also supports basic research on the ways behavioral factors, such as stress and personality traits, influence the course of heart disease. And the lung and blood divisions are poised to expand their behavioral research portfolio, including more research into behavioral factors associated with disease, and into strategies to improve long-term maintenance of health-related behavioral changes, say program officers.

Send in the applications

Many potential behavioral research funding opportunities are detailed in the report released last February by NHLBI?s Task Force on Behavioral Research. The report examined the behavioral work funded by NHLBI to date and highlighted research areas ripe for study.

In particular, the report called for more interdisciplinary research, encouraging psychologists and other behavioral researchers to team up with medical researchers and infuse behavioral measures into a variety of long-term studies of heart, lung and blood diseases. In addition, the report notes, more emphasis should be put on behavioral research related to lung and blood diseases?areas still largely in their infancy.

In fact, a recent survey of NHLBI blood research found only a handful of behavioral research grants, all related to sickle-cell disease, says Carol Letendre, PhD, deputy director of NHLBI?s Division of Blood Diseases and Resources. The studies include work on pain management, measuring pain in sickle-cell patients and assisting patients and families in coping with chronic illness. This is a good start, but the division would like to encourage more.

'We?re trying to launch a new area of behavioral research,' says Letendre. She organized a Nov. 30 working group meeting to discuss the behavioral research areas that the division should be encouraging and the mechanisms it should use to do that.

The Division of Lung Diseases funds psychologists and other behavioral researchers to investigate behavior modification, self-management and motivation. This includes studies on adherence to and compliance with treatment, and on smoking cessation in people with chronic obstructive pulmonary disease, pregnant women and parents of children with asthma, says social epidemiologist Michele Hindi-Alexander, PhD, health science administrator in the division.

But the division would like to encourage other behavioral grant applications, says Hindi-Alexander. In particular, the behavioral research report recommended research in areas that include:

? The influence of psychological and sociocultural factors on asthma.

? The psychophysiological mechanisms that regulate inflammation in people with asthma.

? The effects of prenatal and early childhood cigarette smoke exposure on the development of lung disease.

The report also encouraged the institute?s sleep center to expand its behavioral sleep research portfolio. Potential areas of research include: investigating circadian and sleep mechanisms that influence the time of day people experience attacks related to heart or lung disease, and identifying the effects of sleep loss on stress and risks for heart disease.

Organizational structure

For researchers interested in taking advantage of the research opportunities at NHLBI, the institute can appear intimidating. The NHLBI?s organizational chart doesn?t make it immediately clear where researchers with a behavioral bent might hang their hats. In fact, behavioral research is distributed throughout the institute, concentrating in a few behavior-specific programs, but not limited there.

NHLBI?s extramural research program is split into several divisions representing heart disease, lung disease and blood disease. A fourth division?Epidemiology and Clinical Applications?formed from the heart division more than a decade ago and funds the bulk of NHLBI?s behavioral research from Kaufmann?s Behavioral Medicine Scientific Research Group and the Prevention Scientific Research Group led by Denise Simons-Morton, MD, PhD (see chart).

Along with some applied research and large clinical trials on behavioral treatments for cardiovascular disease (see article page 16), Kaufmann?s research group funds basic research on the mechanisms fueling the link between behavior and disease (see article page 14). Simons-Morton?s research group primarily funds research on the primary prevention of cardiovascular disease, with a strong focus on dietary and physical activity behaviors. And an area of recent interest is how to get people to maintain behavior change once a prevention program succeeds in curbing unhealthy behaviors.

'We know a lot about helping people change behavior short term,' says Simons-Morton. 'But what helps people maintain healthy behaviors?'

Unlike the cardiology folks, neither the blood nor lung division has a separate program devoted to behavioral research. Instead, the behavioral research they fund is incorporated throughout disease-specific research programs within each division.

Researchers interested in learning more about funding opportunities at NHLBI should contact a program officer in their area of interest. It?s an ideal time, say the program officers, as NHLBI re-emphasized its commitment to behavioral research with the release of its report on the subject.

Of critical importance is that researchers send in their applications. The number of behavioral medicine applications coming to NHLBI seems to have declined by about a third since a peak 10 to 12 years ago, says Kaufmann. And if the number of applications decreases, the number that can be funded also decreases. The NHLBI doesn?t have a different payline for behavioral research but rather funds grant applications in all areas by the same criteria. That means that the more good behavioral research applications that come in, the more get funded, says Kaufmann.

The NHLBI report of the Task Force on Behavioral Research in Cardiovascular, Lung and Blood Health and Disease can be viewed on the web at www.nhlbi.nih.gov/nhlbi/sciinf/taskforc.htm.