FY99 CDMRP Annual Report
Section X. Defense Women’s Health Research Program
Congressional Appropriation and Funding Execution
DWHRP Vision and Mission
Program Accomplishments and Outcomes
In FY94, Congressional concerns were raised about the rapidly growing number of women in the Armed Forces and about the dearth of medical research concerning the health risks and health care for these women. As a result, the Defense Women’s Health Research Program (DWHRP) was established by public law (Section 251, P.L. 103-160) to address the critical health and performance issues impacting women in the military. The U.S. Army Medical Research and Materiel Command (USAMRMC) was responsible for managing the FY94 Congressional appropriation. In FY95, program management was assumed by the office of the Congressionally Directed Medical Research Programs (CDMRP).
In FY95, the USAMRMC asked the Institute of Medicine (IOM) for advice on how to manage the DWHRP. The IOM issued a report: Recommendations for Research on the Health of Military Women. Within the guiding framework of the IOM’s recommendations, the CDMRP took steps to develop a research program on the health of military women.
In FY95, Congress appropriated $40M for peer-reviewed defense women’s health research. Table B-6 in Appendix B summarizes the directions from Congress for the DWHRP appropriation, the program’s withholds and management costs, and the investment strategy executed by the program. Prior to receipt of funds by the USAMRMC, Congress and the Department of Defense (DOD) withheld funds for designated initiatives. The CDMRP set aside funds for program development, scientific peer review, programmatic review, and the administration of grants/contracts through the entire period of performance up to 7 years (see Appendix B). The investment strategy executed is consistent with Congressional language and reflects the program’s vision.
The goals of the DWHRP were to provide U.S. Armed Forces with the superior technology that is essential to enable the full spectrum of military operations for crisis and conflict resolution; to protect and sustain service of women and men from battle and non-battle threats to health; to sustain optimal military performance and survival; and to provide the world’s best combat casualty care.
In accordance with the Congressional directive, a representative from the Magee-Women’s Hospital in Pittsburgh as well as representatives from the three Armed Services (the DOD, the Defense Advisory Committee on Women in the Services, and the Office of Research on Women’s Health at the National Institutes of Health) served on the Joint Programmatic Review Committee, forging the investment strategy and implementation of the intramural and extramural programs of the DWHRP.
Intramural Program. Of the $40M appropriated for defense women’s health research, $6.4M funded research projects that were solicited from institutions that are part of an agency or activity of the DOD or other U.S. Military Service Department. Military/civilian collaborations were encouraged but research projects were required to be performed at a military institute.
This program was intended to invigorate research in defense women’s health by fostering new directions, addressing neglected issues, and bringing new investigators into the field. Research applications from female investigators were encouraged. Intramural research proposals were solicited in the following four general areas:
- Major factors affecting the health and work performance of military women
- Psychological and health issues resulting from the integration of women into a hierarchical male environment or related women and men living and working in close quarters
- Health promotion and disease prevention
- Access to delivery of health care
The DWHRP intramural program funded 30 awards in 3 award categories: Clinical and Health Care Delivery (9 awards), Military Operations (11 awards), and Infectious Diseases (10 awards).
Extramural Program. Approximately $23.9M was allocated to research projects in this category. Eligible institutions included for-profit and non-profit organizations, public and private such as universities, colleges, hospitals, laboratories, and agencies of local, state and Federal governments. Submissions by women, minority new investigators, and civilian/military partnerships were encouraged. Extramural research proposals were solicited in four general areas:
- Operational effectiveness for mission accomplishment
- Health promotion and disease prevention
- Psychological health and well being
- Access to and delivery of health care
The extramural program supported 36 grants in 3 award categories: Operational Effectiveness for Mission Accomplishment (15), Health Promotion and Disease Prevention (15), and Psychological Health and Well-being (6).
Tables X-1 and 2 reflect the funding summaries, in terms of dollars and number of awards, for the FY95 DWHRP.Program Initiatives
——National Women’s Health Information Clearinghouse
The National Women’s Health Information Clearinghouse is a joint venture between the DOD and the Department of Health and Human Services. Its accessibility on the world wide web (http://www.4woman.org) includes on-line registration, educational materials, news updates, facilities for user feedback, and direct connections to major women’s organizations. The National Women’s Health Information Clearinghouse will serve as an information resource for clinical, research, and policy issues affecting women in the Armed Forces.
——Defense Medical Epidemiological Database
The Defense Medical Epidemiological Database (DMED) was originally supported by the DWHRP, and is now maintained by the Army Medical Surveillance Activity. The Database was initiated to standardize the epidemiologic methodology used to collect, store, and analyze Tri-Service data to be used by military/civilian researchers and policy makers, and evaluate the health of active duty service members with particular emphasis on women. Eventually the DMED will include Reserve Forces and Veterans Affairs data.
The Database serves as a part of an infrastructure to facilitate research and operational requirements by providing access to Tri-Service epidemiologic data and provides a solution for developing and implementing remote database access. It features user-friendly on-line registration, assistance, and downloading. In addition, DMED connects all Services’ medical department epidemiological databases to the Walter Reed Army Institute of Research and their website so that large amounts of data can be queried in a timely and efficient manner. Hypertext links provide direct access to the Office of Prevention and Health Services Assessment, the Army Medical Surveillance Activity, and the Naval Health Research Center.
During the first 30 months of the DWHRP, grant recipients reported 41 articles in review or in print, and publication of 15 abstracts. The DWHRP also supported the Forum on the Health of Women in the Military, which was held 17-19 June 1996 at the Uniformed Services University of the Health Sciences. Key findings/accomplishments reported within the intramural and extramural programs follow.
In the topic area of major factors affecting the health and work performance of military women, investigators have found that changes in hormonal levels during the menstrual cycle did not have an effect on exercise performance.
Operational effectiveness of military women for mission accomplishment has also been an important area of DWHRP research. Fit testing of a modified anti-G suit showed gender parity in the tolerance and endurance of military personnel subjected to high-G simulated aerial combat maneuvers. Funded physiology studies have revealed that metabolic expenditure to cold exposure is similar for men and women.
Research in the psychological and health issues resulting from the integration of women into a hierarchical male environment has been advanced by the DWHRP investment. Baseline epidemiologic data on the health status of nearly 10,000 Navy and Marine Corps men and women (enlisted and officer personnel) have been collected.
In the area of health promotion and disease prevention, investigators found that organic compounds such as jet fuel, lubricating fluid, and propellant were not found to be teratogenic substances. A CDMRP-funded prospective study of active duty women indicated that all three components of the "female athlete triad" (disordered eating, amenorrhea, and osteoporosis) were present in this population and needed to be prevented.
Finally, access to delivery of health care for military women has been improved through research performed under CDMRP grants. For example, a self-test kit for urinary tract infections has been developed and evaluated. In addition, an evaluation of self-administered swabs to detect sexually transmitted diseases showed results equal to or better than clinic-administered tests.
Table X-1. Funding Summary for the FY95 DWHRP Awards
Table X-2. Number of Proposals Received and Number of Awards Made for the FY95 DWHRP