Presidential Column

Behavioral Research at NICHD

Historically, the National Institute of Child Health and Human Development (NICHD) has always supported research on behavior and psychological growth as fundamental to understanding both normal development, as well as a myriad of diseases. But while behavioral research was seen as important even at the time of NICHD’s establishment in 1962, the ensuing three decades have seen an increasingly critical emphasis on understanding the effects of behavior on health and development. From unintended pregnancy and infertility, to sudden infant death syndrome (SIDS), the list of conditions that may, in some cases, be affected by individual psychology and behavioral choices is growing exponentially. We all know, too, that the way in which people seek and/or adopt interventions largely determines the outcome of a disorder.

For example, we now know that the prevention of unintended pregnancy is an area in which behavioral research is absolutely critical. Currently, unintended pregnancies account for approximately 60 percent of all pregnancies in the United States. Although not all unintended pregnancies are unwanted, they still may hold certain implications, which may be dire, for the child. For example, women who have conceived unintentionally are more likely to expose the fetus to alcohol, tobacco, or other harmful substances, as well as less likely to obtain early prenatal care.

Unfortunately, despite the development of better contraceptives, the rate of unintended pregnancies has not changed. This is due, in part, to behavioral patterns, which NICHD-supported investigators are examining, and limitations on the availability of contraceptives. Clearly, however, much remains to be done; first, by clarifying the psychological processes and behavioral choices that result in unintended pregnancy, and then by developing educational interventions to encourage behavior that minimizes the risk of unintended pregnancy.

At the same time, we also know that approximately 10 percent of U.S. couples suffers the pain and frustration of infertility. In their efforts to become parents, many of these couples undergo a growing array of medical interventions; unfortunately, only an estimated 50 percent of those who seek medical treatment will be successful in overcoming their infertility.

Increasingly, psychologists who work with infertile couples are seeing the profound emotional effects of being unable to start a family and being labeled infertile. How the stress and complex emotional issues associated with infertility can actually affect treatment outcome is just beginning to be addressed as we realize that the “psychobiology of infertility” deserves at least as much emphasis as the biology of infertility. Indeed, NICHD recently co-sponsored a workshop by the same name with the NIH’s Office of Behavioral and Social Sciences Research. Once a child is born, behavioral change on the part of parents or caregivers can help protect the child from one of the primary causes of infant mortality: SIDS.

Investigators in this country and abroad have conducted a number of studies linking infant prone (stomach) sleeping with an increased risk of SIDS, and back or side sleeping with a reduction in risk. Since 1992, when the American Academy of Pediatrics recommended that infants be placed on their back or side to sleep to reduce the incidence of SIDS, the United States has seen a steady decrease in the prevalence of infant prone sleeping. This decrease has been bolstered by the national “Back to Sleep” campaign, launched in 1994 by a coalition of federal agencies, including the NICHD, and by the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS Program Professionals, to disseminate the message to parents and caretakers that back or side sleeping reduces the risk of SIDS.

Already, there are signs that the campaign is working. Last year, a national telephone survey of 1,000 night-time caretakers of infants seven months and younger indicated that infant sleeping practice had changed from 70 percent of infants being placed on their stomach (prone) to sleep, to 70 percent being placed on their back or side. There are encouraging signs that SIDS deaths are declining, especially in states that have active ‘Back to Sleep’ promotional campaigns, and the overall rate is down 30 percent. While these are encouraging signs, much remains to be done. The goal is to get more than 90 percent of infants to be placed to sleep on their back or side by continuing to promote a change in the behavior of parents and care givers.

As these brief examples illustrate, behavioral research plays a pivotal role in NICHD’s research portfolio, with benefits for the health and well-being of individuals everywhere. As we find ourselves propelled more and more quickly into the genetics era, however, we must be careful and we must be vigilant. We must be careful to remember that our genes alone do not determine our health and longevity, but that they work in concert with our psychological makeup and subsequent behavioral choices to do so. And, we must be vigilant to continue the overwhelmingly important research we have already begun on the psychological and behavioral issues related to health and development over the course of the human lifespan.

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