Tommy Thompson, secretary of the Department of Health and Human Services (HHS), recently announced a $2.1 million increase in the Office of Women’s Health (OWH) budget for Fiscal 2003, bringing the total to $29 million. Among the program priorities for Fiscal 2003 are expanding services for women who experience violence, eating disorders, and homelessness.
The OWH sets a comprehensive women’s health agenda and works with other federal agencies to implement it. These agencies include the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institutes of Health (NIH).
A priority at OWH is preventing violence against women across the lifespan. Research has shown that women who are victims of interpersonal violence have higher rates of post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse, eating disorders, and multiple personality disorder than women not victimized by violence.
The OWH chairs the HHS Violence Against Women Steering Committee, which coordinates related activities including maintaining the national domestic hotline, funding grants for community responses to domestic violence, and studying the economic and personal costs of violence against women.
Because eating disorders disproportionately affect women and girls, the OWH is partnering with the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute this year to examine how obesity is linked to eating disorders such as binge eating, said Jones.
"We already know that body image and self-esteem in adolescent girls play an important role in eating disorders," said Jones. The OWH has also formed a partnership with a private foundation to educate the public and health care professionals about eating disorders, she noted.
What about the mental health needs of homeless women veterans? The OWH is collaborating with the Department of Veterans Affairs this year to look at that question and to ensure that HHS programs are available to these women. "An interesting research question is whether homeless female veterans have higher rates of PTSD than other homeless women because of serving in such ‘hot spots’ as the Persian Gulf and Saudi Arabia," said Jones.
Because the surgeon general’s 1999 report on mental health mentioned women’s health only briefly, the OWH is developing a special supplement devoted solely to women’s mental health, Jones pointed out. This will be a joint effort with SAMHSA and the National Institute of Mental Health (NIMH), said Jones. She anticipates the supplement will be released next year.
NIH’s Office of Research on Women’s Health (ORWH) was created in 1990 to ensure that women and minorities were included in clinical research. The same year, the General Accounting Office (GAO) issued a report finding that NIH was slow to include women in research despite its 1986 guidelines urging greater focus in that area.
Congress in 1993 required NIH to include women and minorities in all human-subject research and in sufficient numbers in large-scale Phase 3 studies to analyze differences in responses to interventions. Phase 3 trials are used to test the efficacy and safety of interventions and have a greater impact than smaller trials on clinical practice and health care policy, explained Mary Blehar, Ph.D., director of women’s mental health programs at NIMH.
The GAO reported in 2000 that women made up at least half the subjects in NIH-funded Phase 3 trials. But it found that the number of women in several Phase 3 studies was insufficient to perform accurate gender analyses. The ORWH responded by strengthening its guidelines to require that gender analysis be mentioned in every funding announcement, evaluated by Phase 3 peer reviewers, and included in researchers’ progress and final reports.
The NIMH and the National Institute on Drug Abuse (NIDA) have a good track record of sponsoring women’s health research and gender analysis, said Sherry Marts, Ph.D., scientific director of the Society for Women’s Health Research in Washington, D.C.
For example, NIMH-funded studies have "shown that drug treatments produce different responses in men and women with mood disorders," said Marts.
Blehar noted that although women of childbearing age have twice the rate of major depression as men, little is known about the safety and efficacy of different treatments for pregnant or nursing women. NIMH-funded studies are examining how and when mental disorders occur during reproductive transitions and which treatments may be appropriate for women during their reproductive years, said Blehar.
Other NIMH-funded studies are examining the relationship between stress, gender, and mental disorders, said Blehar. For example, understanding of the "fight or flight" response associated with PTSD has been based largely on studies of men. Researchers found that a common female response to stress was "tending and befriending," which may be related to the female hormones oxytocin and estrogen and brain opiates, she said.
Research sponsored by NIDA shows that biological differences between the sexes affect their involvement in drug use, abuse, and dependence. NIDA is also looking at adolescent behaviors that lead to chronic drug abuse in women with the goal of developing prevention strategies. It is also examining drug treatment for women in the criminal justice system, among other areas.
Cora Lee Wetherington, Ph.D., director of the women’s health research program at NIDA, said, "We have been sending the message to the field that research on women is an important area to pursue." NIDA has cosponsored conferences on psychosocial issues related to drug use and abuse in women, sponsored travel awards for junior researchers to attend national conferences on drug dependence, and funded research programs to improve the medical treatment of female drug users. "I think researchers are beginning to see the scientific value of recognizing gender differences," said Wetherington.
The 2000 GAO report "Women’s Health: NIH Has Increased Its Efforts to Include Women in Research" is posted on the GAO Web site at www.gao.gov/archive/2000/he00096.pdf. The NIH Office of Research on Women’s Health Web site is www4.od.nih.gov/orwh/. The NIMH women’s mental health research highlights are posted at www.nimh.nih.gov/wmhc/highlights.cfm. NIDA’s women’s health research advances are posted at www.nida.nih.gov/WHGD/WHGDHome.html. The HHS Office of Women’ Health Web site is www.4woman.gov/owh/. ▪