Spring 1991

Research and Graduate Education at The University

of North Carolina

at Chapel Hill/Spring l99l/Volume VIII, Number 2

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Vantage Point Tlansitions HEN I tast wrote on this page, I was a newcomer to the Office of Research Services. In those five years since I assumed the directorship, I have seen research on this campus expand to new areas, and, in terms of practical matters, have seen ORS expand from a Y 7-person operation, to one requiring some 20 staff members who address the increased demands of a growing research community. The 0ffice of Research Services has been in steady transition during these years. We have learned new things and provided many new services along the way. The office now faces a fresh transition as a new guard takes over.

While at my ORS post, I learned that the directorship should be, above all, a communication center. The needs and aims of our researchers are as diverse as their personalities. Our research

U

community must hear about sources of funding and provisions which may regulate them, as well as receive assistance in putting together proposals. We have tried to meet many of these needs through our funding library; our publications, including a newsletter, a monthly column in The University Gazette and the magazine you hold; visits to departments; and organization of symposia, classes and worhhops. Electronic bulletin boards, available campus-widg have been developed to facilitate and spread information transfer. To reach everyone is a difficult task so we endeavor, always, to improve and expand these services. In return for these efforts and in response to the hundreds of orciting proposals talented researchers at UNCCH have submitted, the University has seen a 7 percent increase in federal, state and private funding over the last year; 95.4 percent since 1985. Funding from the National Institutes of Health alone increased nearly 160 percent during the past five years.

It is significant, too, that these increases took place during a period of unprecedented federal supervision and unparalleled expansion in the number and the scope of regulations applied to university-based research. The research community has for some time worked cooperatively with federal agencies to create and maintain the highest standards for protection and humane care of animals used for experimental purposes. Indeed, the same is true of the protection and welfare of human participants in empirical research.

Most recently the behavior of the researcher has come under greater federal regulation and scrutiny. For example, one is now held to standards defining scientific integrity and ethical behavior so that research can be carried out responsibly. Researchers, particularly those supported by federal grants, find that the very nature of the workplace has changed so that all investigators, and not just their institutions are responsible for researchers' actions. These transitions are by n0 means negative, but the administrative burdens associated with the new standards of conduct now compete with research for the investigator's time and attention. It is hoped one preoccupation will never work to the disadvantage of the other. lf I were to make a wish for the future, it would be that the arts and humanities take greater advantage of the available extramural funding, and, moreover, that successful departments or individual investigators serve as information resources to inspire greater activity and growth. 'ftansitions are healthy, indeed they can invigorate an institution by providing new perspectives and new solutions. In fact, with this issue of, Endeavors, we have begun to explore new editorial directions and design elements-we hope that many more changes will be possible in the future. I know as I return to the laboratory and my own research, that the work at the Office of Research Services and the work by campus researchers, will continue to find new perspectives and offer new

Ll ), solutions.

Tom K. Scott

Professor of Biology and Former Director of the 0ffice of Research Services

Research and Graduate Education at The University of North Carolina

at Chapel Hill/Spring 1991/Volume VIII, Number 2

COVER STORY

2

Rooted in the Betwixt and Between

fuo

Endeavorc

Professors Explore the History and Politics

of Central

Africa

Research and Graduate Education

by Lisa Blansett

at the

University of North Carolina at Chapel Hill Spring l99l

Damaging Consequences

Volume VIll, Number 2

7

The Long{erm Effects of Childhood Sexual Abuse

by Dottie Horn

Endeavors is a magazine published three times a year by the 0ffice of Research Services

at the University of North Carolina at Chapel Hill. Each issue of f,ndeavors describes only a fen,of the many research projects under-

Chapel

10

taken by faculty and students of the University.

Hill

Reports

Rewarding Research

Corporate Cooperation Requests

for permission to reprint

material,

by Scott Lowry

readers' comments and requests for extn copies should be sent

0ffice of

to Edilor, Endeavory

Research Services, CB# 4100,

Where There's Smoke

300 Bynum Hall, The University of North

12

Carolina at Chapel Hill, Chapel Hill, NC

Researchers Monitor Passive Smoking

in

lnfants

'

275994100 (9r9/96G5625).

by Lisa Blansett

Chancellor: hul Hardin Provost: J. Dennis 0'Connor

Blood Relations

Associate Provost and Dean of Research:

15

Mary Sue Coleman

Studying Sickle Cell Mutual-Help Groups

Director, 0ffice of Research Services: Vacant

Editor-in{hief: Tom K.

by Scott Lowry

Scott

Managing Editor: Brenda Powell Assistant

Out of the Rat Race

Editors: Lisa Blansett

18

Dottie Horn

Changing an Infant Rat's Response to Stress

by Dottie Horn

Scott LovnY Photographer:

Will 0wens

Design: UNC Design Services

O l99l by the University of North Carolina at Chapel Hill in the United States. All rights reserved. No part of this publication may

k

reproduced without the consent of the University

of North Carolina at Chapel Hill.

Cover: David and Catharine Newbury interviewed hundreds of Central Africans like this elderly man for their studies of culture and social relations. They often lived in rural villages for months to reach a grass roots understanding of the culture and social change.

Courtesy of David and Catharine Newbury

Rooted in the Betwixt and Between TWo Professors

Explorc the History and Politia of CentralAfria by f,tre BlencGtt

6 I

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ENTRAL Africa is generally understood by American audiences in mythic proportions

-the

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journey to the bottom of the soul

in Conrad's Heart of Darkness, the

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voyage to O

essential humanity in Bogart and Hepburn's Ahican Queen. Though victim to many Western stereotypes, Africa is an area not unknown to all Westerners: it has become home for two UNC-CH professors who have spent a good part of their lives seeking to understand this diverse and fascinating area.

Catharine Newbury an associate professor who teaches in the political science department and the African and AfroAmerican Studies Curriculum, and David Newbury an associate professor in the history department, as spouses and colleagues have spent some 14 years studying in and making trips to Uganda, Tanzania, Rwanda and Zaire. In examining the complex relations that make up various social formations at different periods, they have found many Western assumptions are unfounded.

In addition to teaching a variety of courses on Africa, they have worked together or separately on four related projects. One study examines the social transformations which preceded the Rwandan Revolution of 1959-62. Another focuses on the formation of a new social order in an island kingdom in Zaire. A third considers the changes

in social relations as a result of

a

shift from a trapping-gathering way of life to agricultural production. Yet a fourth project shows how a severe famine in eastern Rwanda in 1929 unveiled (and intensified) many of the underlying historical conflicts within the society.

Their research methods resemble those of

cultural anthropology more than those associated with conventional political science or history.

They haveled on foot, over rough terrain, and then settled in villages for long periods to gather the oral accounts which serve as the basis for their own understanding of the history and social life of the area's people. And they experienced their share of tropical diseases, working in what Westerners would think of as desperately

't o h O

began her study of the social preconditions to the Rwandan Revolution, she basically accepted

the prerailing assumptions about its causes. "ln most of the anthropological literature about Rwandal' she notes, "it was assumed that the kinds of inequalities that odsted in the 1950s, after colonial power had been in place for half a century were inequalities that had characterized Rwandan society for centuriesl' Rwanda was seen as a static society; it was assumed that the dominant, minority group, the Ttrtsi,

had exploited the Hutu majority long before the Europeans colonized the area.

In 1959, howwer, the Tirtsi monarchy was overthrown in a revolution which surprised many by the intensity and violence on both sides. "To explain this phenomenonj' Catharine Newbury notes, "analpts looked to the outside, to external influences, to account for such disequilibrium in a society they presumed had been well-integrated. My work sought to understand the internal forces that led to this revolutionl'

David and Catharine Newbury ennine slides they have taken during their rcsearch in Central Africa.

primitive conditions, to arrive at a grass-roots understanding of the culture. "Historical understanding must proceed in the first instance from understanding local perceptions of that history. Even if local concepts of history don't always conform to what professional historians or outsiders think, the people who lived that history often have the greatest insight into itl' explains David Newbury. "We are bothl' says Catharine Newbury "questioning what was the accepted wisdom about the primordial nature

of various institutions and conceptsl'

The Dcnlre of Preconcelved iloffonc Such a skeptical position was not always so well defined, however. When Catharine Newbury

The premiling theory uplained social hierarchy in colonial Rwanda by reference to a premise of inequality, emphasizing the supposed psychological predispositions of the different classes. 'According to this view, all Rwandans believed that the Thtsi were born to rule while

Hutu accepted their station in life; they believed that they were born to be senantsj'Catharine Newbury notes. But such understanding was built almost exclusively on information hom the lbtsi ruling elite, for whom the premise of inequality was a given. ln their eyes they were superior and had alwap been sq Catharine Newbury explains; Westerners assumed that social differences in Rwanda simply represented the atavistic remnants of a socalled traditional past. Moreover, an assumption of the primordial quality of ethnic differentiation provided a convenient justification of colonial stratification.

"0nly by stepping outside of such colonial perceptions was I able to judge the historicallycontingent nature of such assertionsl' sap Catharine Newbury.

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ethnic self-consciousness led Hutu rncreasinqly

to see themselves as a single group, sharing a comm0n status vis-a-vis the TLtsi elite. This produced a sense of cohesion as they worked to improve their conditions.

In Catharine Newbury's view, "social

UGANDA

iden-

tities are not driven exclusively by primordial loyalites. They are historical constructs, often realized through a recognition of common status and common struggles. My book, The Cohesion of )ppression, documents this process 0f group formationl'

Of Kings and Clans

Tembo Region

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ZAIRE

RWA NDA

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ljwi

TANZANIA

irhe rYerrburi,s spent nost of their resean:h ttne liyinc tn villaqes in Zaire and Rwanda. llhile l{bsterners tenrl set' .Africa in ctnenalic ri.,:ions of lhe .Sereirqeli "s desert plains and the Congos tropit:al jungles. Zaire and

to

Rwanda iealure landst:apes that

like hichlands. nountain

The Local Roots

ran'hon

sparsel.r w'oodedsatannas.

to dense equatorial rain t'orest tr-t Alpine-

lakes and .;now.ct:ered peaks

of f,istory

To understand the historical factors which had led to such social stratification. Catharine Newbury set about t0 reconstruct the social history of one region of the countrv fiom about 1860-1960. To do so, she drew on oral accounts of many different people who had participated in, struggled with and been vic-

timized by these transformations. "Over the course of my research it became clear that the

of Rwandan society had some serious flaws,' she notes. The premise of inequality failed to see elite portrayals as peraccepted portrayal

ceptions bounded by social ciass. Hutu saw

things differentll, from Tutsi-and this was especially true for Hutu in the peripheral regions. where the historical preeminence of Thtsi power was more recent and more clearly a result of the interplay of colonial power and local initiatives. "The plav for power was s0mething far different from the premise of inequality;' she says. "The data I collected made it clear

that concepts of inequalitv were not the cause, but the result of political subordinationl' To explain the revolutionary violence of the late 1950s, Catharine Newburv needed to

explore how increasingly intrusive state power shaped relations between gioups. Important changes had occurred well before colonial expansion reached the area in the late 19th century, but the growing rifts between the Hutu and Ttrtsi were intensified by colonial rule. The Belgians defined Rwandans along racial lines: "Because the Belgrans thought the Thtsi looked

more Caucasian, they assumed the Tttsi were more highly endowed intellectually and more competent than the Hutu, who were regarded as country bumpkins, incapable of intellectual activityl' according to Catharine Newbury. Thus the colonial educational system favored the TLtsi.

By the 1950s the Tltsi had become extremely exploitative, expropriating land and threatening to fine, beat or exile anyone who disobeyed.

The rise in state power meant that Hutu were required to perform unpaid labor on roads. plantations and other colonial enterprises under abominable conditions.

"These changesl' says Catharine Newbury, "led to a situation where Hutu became quite conscious of being exploited: They began to see themselves as an ethnic groupi' Whereas in earlier times group identity was based on ties of family and locale, the transformation in

While Catharine Newbury argues that the emergence of new local identities challenged the centralized colonial state, Davtd Newbury takes a somewhat different approach. [n another research project he focused on the emergence of a new kinqdom on Ilwi Island in Lake Kivu during the late lSth and early 19th centuries.

Rather than threatening central power as in the case of the Rwandan Revolution, he argues, intensified local identities contributed to the consolidation of such power. "ln many historical situations, lower-level social identities were not in conflict with the growth of a cen-

tral dynasty; in some instances, strong lineage identities facilitated such changesi' Among the most unifytng aspects of the Newburys' work is their work along borders, borders that are conceptual or metaphoric as well as those between eras, between social groups, between cultural traditions, between countries. Ijwi Island, for example, is on the boundary between Zaire and Rwanda; it is also located on the divrde between equatorial rain forests to the west and highland plateau to the east. Social relations in these areas are as different as the landscape. "East of Lake Kivu the cultures are characterized by centralized kingdoms, concentrated political power, highly stratified social levels, and mixed economies of agriculture and cattle herdingi' he says. "To the west of Lake Kivu, one moves quickly into heavily forested areas, characterized by miniscule

political units with highly diffuse forms of poiitical power, more egalitarian social structures, and economies based on trapping and gathering rather than pasturage and agriculturei' Instead of being isolated by the lake, ljwi Island served as a convergence zone for these two political cultures. "In my historical reconstruction, I was able to trace changes in social

forms as the island culture moved from a forest model closer to a highland modell' says David Newbury. "l focused on the social changes that preceded, and made possible, the creation of a kingdom on this island, a community without previous royal traditionsi'

voR.s

But this was not just a study of liwi-an island 25 miles long and about 3 miles wide, with a current population of about 80,000.

"While geographically distinct, the island was not socially isolated; one can only understand historical changes on liwi by understanding its contextual relationship with mainland areasl'

to explain changes on liwi it was t0 account for the transformations

Consequently, necessary

occurring in areas around Lake Kivu; hence what started as a study of a single, rather small community became truly regional in focus.

This analysis required intense work among the local islanders. He conducted some 700 interviews on the island itself, and many more on the mainland, gathering oral accounts of the history of each family, each clan, each village on the island in order to understand how social relations were perceived on ljwi and how they had changed over time. "The people that I interviewed changed my topic. I started out with questions derived from the pre-existing literature and my own superficial understanding of the area. It turned out that many of those

scriptions of ljwi accounts. But my analysis was deeply informed with their understanding of historical relationshipsl' For example, one of the most entrenched assumptions about Africa, according to David Newbury, lies in the claim that the continent has always had a stable clan-based social structure, founded on descent groups known as lineages. "Yet while there were families on

ljwi, corporate lineages did not exist. That was puzzling, because it did not fit our theoretical models of social organizationl' Even more puzzling, it also gradually became clear that while clan identities are today very intense and clearly defined, they had not always been so. Far from being enduring identities, unchanged though many centuries of time, they have proven very fluid, very malleable, changing with evolving political contexts. And far from being defined from the bottom up, based on descent ties, clan ideologies had coalesced from the top down: clearly defined clan structures and the centralization of government had, in essence, emerged together and

questions were irrelevant or misguided; the people had t0 set me straight. Even so, my

reinforced each other. "l resisted this conclusion for a long timei' says David Newbury. "lt went against all

historical conclusions were not simply tran-

the shibboleths of the disciplinel' But the data

he collected from ljwi Island finally compelled him to challenge the accepted attitudes of his discipline. The data from ljwi indicated that clan structures had changed, that they had intensified over time, and that they contributed to the growth of central authority. All these conclusions went against the assumptions of most anthropological and historical models.

Material Culture and Social Relations The Newburys tapped into another area of fluidity that challenged accepted interpretations when they studied the social effects of changes in material culture among the Tembo people of Zaire, Iiving in the tropical forest west of Lake Kivu. Before 1930 the economic structure of this area centered on trapping and gathering, with the two genders sharing equally in these activities. During the 1930s, however, the Belgians opened mines nearby. "Rather than hiring local people to work the minesl' says David Newbury, "they preferred to recruit workers from distant areas, t0 prevent flight and refugei' Local communities were required t0 engage in agricultural production to feed these miners. Moreover, the Belgians required that men work away from the E

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road to welcone a Visiting Mission of the Llnited Nations Trusteeship Council. At the end of colonial rule in the late 1950s, the ")ur fields, please," an appeal fot land; "Down Hutu majority overthrew the 1btsi ruling elite during a violent revolution. The Hutu's handlettered signs read, from left, "Long live Rwanda; Long live Belgium; Long live the United and with immediate independencei' Down will follow. independence Democracy first; with Tlttsi colonialisn:

Hutu Rwandan demonstratots line the

Nations."

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This study required living in a village of some sixty families for about a year. Despite the their field-wolk experience at the local level,

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their research carries important implications for understanding the relations of agricultural history and social change elsewhere in Africa. "0ur experience in Biriko led us to pursue much broader questions on the nature of colonial agricultural policy and the ways in which those policies were enforcedl' says Catharine Newbury.

"There's been a lot of work done on the agra-

rian crisis in Africal' she says, "and it's always been outside experts making recommendations and dictatrng policy. 0ur study provides an investigation on the ground-on what African producers are actually doing and what is being done to them. We seek to understand the real diffrculties and constraints they are facing-

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political as well as environmentall'

The Burden of Western Ideas Not all outside prescriptions have been bene-

*ffi eittlr/ta.srr s,1: plar-ed

licial to the people of Africa. Among the ways the Western world has tried to help Africa solve its agricultural problems is by encouraging increased production of cash crops over the last 20 years. In Biriko, for example, African

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village on colonial projects. "That meant agricultural production fell almost exclusively to women. and men were often absent from their own villages,' he says.

Such forced chanqes in production had profound implications on the structure of this societv. As aqrir ullure bet ame so imp0rtant. so did permanent rndividual claims to land,

farmers have become involved

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women as primarv producers, says David Neuburv. males began Io insist 0n more enduring marriages. Because of clearly defined land riqhts. inheritance and hence descent became significant issues; children would therefore become part of an identified lineage with specific claims to a territory that is a productive piece of land. Under these conditions. lineage

in the

production

of peanuts for sale on the market. "ln some of these areas it's a two or three day walk to the road;' says Catharine Newbury. "But these people still carry 50-60-pound loads of peanuts down to the road and sell them. It's a difficult situation for the producers because when they get to the road, the merchants there virtually dictate the price-and often they offer only a tiny proportion of the market price in towni' Such a change in material production has also contributed to soil exhaustion and deforestation -environmental issues that have finally attracted the world's attention. Thus African cash crop producers are caught in a classic double bind, whrch has more than a little to do with Western

replacing group trapping rightsl' explains David Nervburu ln trapping-gathering cultures, mobility is the highest social priority-vou go where the game is and where the mushrooms are.' Within this hunting-gatherinq culture. marriages were verv fluid. Women had an important say as t0

identitv assumed a new importancei' Interviews on the life histories of some 40 women in the village show how, with lineage claims increasingly important, women were less

policies.

free to define marriage or seek divorce. "The place of women in qeneral therefore was drama-

n,hom-and whether-they' would marry;

tically transformed, as lineage structures altered in response to changes in material production.

Thjs rs an interpretation that goes against much earlier anthropology, which argues that concepts of kinship determined all social relations -including economic production and exchange among peoplel' explains David Newbury. "ln

Rwanda in 1929. While this area had experienced many severe droughts in the past, the 1929 famine was particularly severe and saw

sepa-

ration and divorce could be initiated either by w0men

0r

men.

With the new emphasis on agriculture and the attendant valuation ol land, however, new social ideologies were developed in order to establish unequivocal claims to land 'With the

this case, changes in materjal production

forced

A final example of the interplay between outside forces and local productivity is provided in the Newburys' study of famine in eastern

human losses in the hundreds of thousands.

But this famine was more than simply an instance of droughtinduced starvation. Instead the famine must be understood in its larger colonial context. "As I looked more closelyl' says David Newbury, "many diverse historical

strands appeared to coalesce and coincide at

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the time of the famine. The drought simply brought to a head multiple tensions that had been building during a turbulent period in

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these peoples' livesl'

Four separate but mutually reinforcing factors seemed particularly significant. Before colonial rule, this area had been largely auton' omous from the Rwandan central court, and famine conditions, which put a premium on the control of pasturage and marshland, intensified conflicts between the colonially-imposed chiefs and the local population. [n addition, after World War I this region had been briefly ruled by Britain, in ways which differed significantly from Belgian policies introduced later, in which forced labor was a prominent feature.

The population therefore had a strong sense of alternatives to Belgian colonial policies. Third, the famine intensified a long-term pattern of labor emigration from the area. Thousands of people fled the forced labor policies in Rwanda to seek work in the British territories to the east. And finally, this region had been proselytized by British protestant missionaries, who were often at odds with Catholic missionaries favored by the Belgian government. It was the missionaries who first brought news of the famine and of its disasterous effect on the local population to the attention of the world press. Given earlier colonial competition between the two powers, the administration saw these

news reports simply as British machinations to discredit Belgian rule and eventually t0 annex this area to British territory.

So the famine reasserted old cleavages on many fronts-between chiefs and commoners, between adminstrators and laborers, between Protestant and Catholic missionaries, between Belgium and Britain. [n the aftermath of the

famine-and to block local inititatives-the Belgians initiated new colonial policies which were much more intrusive, much more intensive than had existed before. "Belgian authorities called for much greater levels of forced laborl' notes David Newbury, "particularly forced agri' cultural labor, to require people to produce surplus food crops. Nominally this was t0 prevent famine from recurring; in fact much of the food was exported to Belgian mines in the Congol'

In part, then, both the tradition of

intense

administrative intrusion in peasant agricultural practices and the tradition of ongoing resistance by African peasants are legacies of early colonial policy, and these two legacies bedevil African agricultural production still today. "ln a

this accounts for contradictory western policies which call simultaneously for capturing the African peasantry (i.e., forcing them to produce what the experts decree), even as they sense,

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in patterned robes and holding branches, the King of ljwi Island, Ntambuka Barhahakana, pafiicipates the annual "first huit!' (Muganuro) cerenony with island ritual specialists who represent various clans.

Contrary to accepted wisdom about social relations in the area, ljwi island did not always have a king and clans based on kinship ties. Potitical identities changed radically over tine, and the present clans and kingship energed together, each reinforcing the other's development.

Dressed

in

call for opening up a so-called free market in agriculturel' notes Catharine Newbury.

But the Newburys do not primarily address current policy concerns in Africa; instead they seek new ways of understanding changes in peasant societies. Their reinterpretations of the factors that facilitate such changes carry implications for the nature of historical inquiry and social understanding rather than directly affecting

"Our studies methods of understandlot about have a to say ing history-we try to identify what some of

Western policies towards Africa.

the blinders have beenl' says David Newbury.

"But that can only be done by moving beyond Western conceptions-or misconceptions-and listening carefully to the people who live that historyi' Nonetheless,

while they seek new forms of

historical understanding, the Newburys don't simply reject earlier conclusions-they do much of their work in colonial archives as well.

"Colonial history and African history are not opposed histories; for the people who lived there, they were one and the samel' notes David Newbury. "[t is not our objective to counter-

pose an African history to a colonial history, but to transcend such perspectives, seeing their interrelations. By bringing to bear informed alternative views on historical issues that had previously been portrayed as well-understood, we bring up questions about methodology and analysisl' he continues. "fuenty years ago, historians who relied on oral accounts or saw history as a series of perceptions, were dismissed by those who claimed that oral sources were unworthy of scientific credibility because they were fluid, contextual and variable. Now, with the influence of literary analysis, it is widely accepted that all historical sources need be judged as contextual, fluid over time and variable by social classl' Tapping into the flow of power, structure and history is the Newburys' modus operandi.

Their work focuses on finding that point betwixt and between several converging factors, and then pushing deeply into local culture. By straddling borders between nations and cultures,

but also stretching into new conceptual

arenas

that challenge accepted wisdom, the Newburys put down roots in a place of their own.

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Danraging Gonscquence$ The Longterm Effects of Childhood Suual Abuse

by Dot{fle Eorn

HILDHOOD sexual abuse, though more in the public eye than formerly, remains a largely unseen problem. Its preualence might shock many: studies vary but indicate that between 6 percent and 51 percent of women report contact-sexual abuse before the age of 18. The isolated suffering of survivors of childhood sexual abuse is also unseen, because many tell no one until years later. The longterm consequences of childhood sexual abuse are also unseen. 0ccurring years after the abuse,

Pllot Study: Symptom Patternc Abugc Surylvorc

in

specifically for this study, histories were supplemented by recollections of staff members.

Corrigan and Garbutt's work began retrospectively, with a review of the charts of all women

The researchers divide patients into three groups: those with no sexual or physical abuse (22 percent of the total); those with sexual

admitted to the Clinical Research Unit of Dorothea Dix Hospital since 1987. The charts of 68 women had sufficient diagnostic detail

abuse only (24 percent of the total); and those with sexual and physical abuse (49 percent of the total). Women without abuse histories

these consequences are often not attributed to the abuse, according to UNC-CH School of Medicine researchers Mark Corrigan, clinical assistant professor of psychiatry and James Garbutt, associate professor of psychiatry.

Corrigan and Garbutt attempt t0 document these consequences by showing that mental health problems, called psychopathology, are more prevalent in adult women who were sexually abused as children, and that these women exhibit specific types of mental health prob lems. Ultimately, Corrigan hopes that "front-line clinicians will recognize and incorporate into

their daily work the importance of early-life trauma. This change will then help with the early identification and treatment of these patientsl' According to Corrigan, because trauma survivors often have physical or multiple psychological complaints, health practitioners not sensitized to abuse can be misled. "The patient

who is a sexual trauma survivor may come into a hospital l0 or 15 times before the diagnosis is madel' says Corrigan. "lf clinicians treat the symptom when traumatization is the underlying cause,

their treatment may provide some relief,

but it's rarely curativel'says Garbutt.

Emphasizing the role of environment in the development of mental illness is another of the researchers' aims. "The prevailing ethos is that there's no twisted thought without a twisted

gene-that there's a chromosomal abnormality associated with major mental disorder. Well, many trauma survivors have maior mental

disorders-they're very sick, yet, I don't believe they were born that wayl'says Corrigan.

Ma*

Corrigan, clinical assistant professor of psychiatry and

investigate which aspects of childhood psychiatric outcomes in adulthood.

Janes Garbutt, associate professor of psychiatry suual abuse, such as early age of onset, nost negatively affect

for the study. Using their charts, researchers

averaged 2.1 psychiatric diagnoses, compared to

collected information about patients' diagnoses and histories of sexual and physical abuse before age 18. Because trauma histories had been collected for general purposes rather than

2.9 for women with histories of sexual abuse alone and 3.8 for women with histories of both sexual and physical abuse. This was a significant group difference. Noting the diagnoses of

N.DEA

the women in each group, the researchers found, as have other investigators, a significant

Doet Chlldhood Sexual Abuse Chango f,ow the Braln Workc?

association between abuse and certain diagnoses:

borderline personality disorder (a longterm, engrained pattern of unstable and intense interpersonal relationships, unstable mood-such as a rapid progression from depression t0 rage to anxiety-chronic feelings of emptiness and recurrent suicidal threats); dissociative disorders (disturbances of identity and memory ranging from amnesia, flashbacks or recurrent nightmares t0 the more severe multiple personality disorder); panic disorder (sudden feelings of overwhelming panic, anxiety, doom, and feelings

of imminent suffocation or death,

accompanied

by physical symptoms of anxiety, such as a rapid heartbeat); and dysthymia (chronic nonmajor depression). These diagnoses were most prevalent in women with physical- and sexual' abuse histories, somewhat less prevalent in women with sexual-abuse histories alone, and least prevalent in women with no history of abuse (See chart).

Although this study did not indicate a cor' relation between traumatization and major depression, the researchers believe this is likely due to the nature 0f the study population-that is, most patients, regardless of their abuse history, were referred because of depression.

Major depression, say the researchers, refers to more than the usual reactive sadness t0 events that everyone experiences and typically involves a depressed mood, sleeping difficulties, decreased appetite and a diminished interest in the environment for two weeks 0r more. Corrigan and Garbutt believe that, when compared to the general community, trauma patients will show a greater prevalence of major depression.

The researchers found interesting that sexual abuse compounded by physical abuse produces a greater incidence of psychopathology than sexual abuse alone. Because their data is collected from chart histories, say the researchers, they cannot determine whether physical abuse as a compounding factor is, in fact, mistreal ment separate from sexual abuse or, rather, the use ol a weapon 0r beating in a sexual context.

Other researchers have found that when sexual abuse is accompanied by the use of a weapon or beating, a worse psychiatnc outcome results.

To more carefully distinguish physical from sexual abuse, Corrigan and Garbutt have developed a detailed interview to gather information about abuse histories.

Ilaumedc Llfe Eventr Intervlew This interview, designed by Corrigan and Garbutt, is a modification of the Traumatic Antecedents Scale, an interview developed by Drs. Judith Herman and Bessell van der Kolk

In addition to documenting behavioral conse' quences of abuse, Mark Conigan, UNC-CH clinical assistant professor of psychiatry proposes

to show that abuse changes how the brain worla. ln the brain, says Conigan, nene cells, called neurons, communicate with each other through neurotransmitters, substances which lie

in spaces between them. Corrigan's work suggests that, in abuse survivors, this communieation between nerve cells does not work as well as in a non-abused

person.

Communication between nerve cells cannot be measured directly, says Conigan, so he studies what can be measured: the release of hormones in response to the brains control.

Conigan is particularly interested in the neurotransmitter serotonin, which is implicated in a number of psychiatric disorders, including depression. His interest grew from the work of

Dr. Robert Oolden, a UNC-CH researcher who studies the role of serotonin in depression. As serotonin affects the release of the hormones prolactin and cortisol, Conigan administers a

drug-chlomipramine-that block the release of serotonin. He then measures the amount of prc lactin and cortisol in the blood. By comparing the amount oi hormones released in female

to collect information about sexual

abuse,

physical abuse and the witnessing of domestic violence. Corrigan and Garbutt designed their interview to ask directly whether patients have had particular abuse experiences. Researchers have found that the use of probe questions is

most likely to elicit details about sexual abuse history. Corrigan and Garbutt's interview progresses from inquiries about emotionally neutral material to specific probe questions about emotional, physical and, finally, sexual abuse.

Corrigan and Garbutt's Traumatic Life Events Interview defines sexual abuse as "unwanted physical contact involving the breasts, genitals or anal area of the subject or perpetrator prior to age 18 or similar sexual contact, wanted or unwanted, when the subject is less than age 13 and the perpetrator is at least five years olderi'

The interview inquires into factors that past researchers found associated with the severity of psychological impairment of adults: the use of a weapon or beating; the father or stepfather as perpetrator; more than one perpetrator; more than one incident of abuse; vaginal or anal penetration; an older perpetrator (age 26 to 59); and an early age of onset (before age l0). Moreover, Corrigan and Garbutt ask about factors other than childhood sexual abuse that have been found to contribute to a negative psychological outcome: physical mistreatment separate from sexual abuse

prior to age

18;

abuse survivors and

in

non-abused women,

Corrigan can determine whether the serotonin is functioning differently in the abuse survivors.

With l0 lemale psychiatric inpatients who suffered sexual abuse prior to age 14 and l0 non-abused women, Corrigan compared results of this test. He found that, in the abuse survivors, significantly les prolactin and cortisol was released into lhe blood. This suggests, says Corrigan, that serotonin is not functioning normally in abuse survivors.

This finding is important, according to Conigan: "[Although] everybody's long assumed that, on a psychic level, the things thal happen to us when we're growing up do change who we become, no one's ever shown that psychic events can change the way brains work on a biochemical level, [in a way] that is measurable in people's brainsl' Such a discovery might have therapeutic implications, says Corrigan: "Changes that are evident biochemically may be rwersible through pharmacological methods. But that's down the linel' With such goals in mind, Corrigan, with the aid of a grant from the Foundation of Hope for the Prevention and Tleatment of Mental lllness, will continue to explore how serotonin functions in abuse survivors.

witnessing one assault between members of household prior to age 18; parent or caretaker repeatedly demeaning subject prior to age l8; sexual abuse occurring after age 17; and physical abuse, separate from sexual abuse, after age 17. [n addition, Corrigan and Garbutt inquire

into factors found to help mitigate the effect of the abuse: the subject confiding in and receiving support from someone regarding sexual abuse prior to age 18; and the presence of one 0r more adult figures whom the subject, prior to age 10, can trust or who emotionally support the subject. ln future research, Corrigan and Garbutt hope to create an extensive collection of individual case histories-in which the presence 0r absence of the above factors is associated with particular psychiatric outcomes. With this information, they could calculate the extent to which each factor contributes to the severity of psychiatric outcome. Once each factor is weighted, the Tlaumatic Life Events lnterview could be used to score the severity of an individual's sexual abuse experiences. Corrigan and Garbutt believe that such a scale would make finding accurate associations between sexual abuse and psychiatric problems more likely. [n many studies to date, say the researchers, trauma has been scored as present or absent without acknowledging that traumatic experiences occur across a spectrum

ol

severity.

Comparing Psychiahic Inpatients to

Community Conhols

ff

The future study CorriQan and Garbutt have planned involves 100 randomly selected Dorothea Dix female inpatients, who may or may not be discharged before taking part in the study. For each inpatient, two controls-that is, two women of approximately the same age, race

W. Wa:-t::lEs*t

'.

&l

:

and income-will be selected from among women attending the Wake County Public Health System family planning clinic.

Individuals selected for the study will complete two interviews in which a psychiatric nurse trained to evaluate answers will ask a standard series of questions. Based on the first interview, a nurse will evaluate psychiatric symp-

toms and diagnoses. In addition, information will be collected about participants' alcohol and drug use, self-injurious behavior, psychiatric hospitalizations, and family history of psychratric illness. At the second interview, the Traumatic

Life Events Interview is administered.

The information collected in the interviews

will not only be used to

an instrument to quantify sexual abuse, but also to re-examine nany of the issues raised in the pilot study. create

Both the inpatient and community populatrons

will be studied to

determine whether women with histories of early sexual abuse exhibit a characteristic profile of symptoms and psychiatric diagnoses, say the researchers. The research

team predicts that women with a history of sexual abuse will show more psychiatric diagnoses over their lifetrmes, as well as more current psychopathological symptoms, than women

without a sexual abuse hrstory. Specifically, Corrigan and Garbutt predict finding more dissociative diagnoses, more borderline personality disorders, and more panic disorders,

as

well as more suicidal and self-injurious behaviors, in the women with a history of sexual abuse.

Because, as indicated

in the pilot study, the

ABUSE AND PSYCHIATRIC SYMPIOMS 0hlef Charecterlodcr: Wencr (r=15)

rltt

Eo

{

3"

\.., r,i i"r i|r.lr ,l l;ri1'11;lir\ .l,tnlrs (i,ril,it{l siri' li 'i.ltL,,,i , Ir'dt Ilrr' 5\nt]li(lirr ulren It, tritrlr't Lt lttl 1,111r,' illi- t l1't,.rlltr,, :l Ill ii lrl \rrJe :L :t ,, tt,itt,i. l,tLi 1 : tiirt lv ittattve.'

traLltratrzation is

L

Dorothea Dix population does not reflect the suspected correlation between childhood sexual abuse and major depression, the prevalence of this disorder will be studied only in the community population. ln the community. women with a history of sexual abuse are expected to show more major depression than women

without a history of sexual abuse. Community women with a history of sexual abuse are also expected to show a greater lifetime use of mood altering drugs.

More generally, Corrigan and Garbutt hope to establish that childhood sexual abuse is associated with adult psychopatholoey. They expect to find an increased prevalence of sexual abuse in the women admitted to Dorothea

Dix than in women from the community-based control group. Among the Dorothea Dix patients, those with a history of sexual abuse are expected to show more frequent psychiatric hospitalization and an earlier age at first hospitalization than subjects without a history of sexual abuse.

The pilot data and the more extensive hypotheses it suggests indicate that sexual abuse-however unseen-is not only prevalent but pernicious, resulting in Iongterm psychiatric consequences in adulthood. By documenting this connection and the symptoms Iikely to result from early sexual abuse, the researchers aiert clinicians and sufferers to an often unsuspected problem and provide a base not only for future research, but also effective treatment.

lorderlhc

Auy

?cneoldtty

Dtrcochdvc Dborder

Prrlc Ilbor{cr

fftfyrlr

Unstable relationships

Problems with identity

Anxiety attacks

Chronic non-major

and moods

and memory

llborder

depression

Lldory ol ebsre no/

t/o

7%

0%

13%

ebarc ody (r=16)

19%

s6%

37%

31%

Wonon wtfh htrtory of rond erd ptryrtcd $urc (r=33)

58%

88%

70%

67%

Woner

wltt htrtery of rcxld

D.E.A.V.O

l0

Rewardlng Rccearch

Chapcl

hAULINE

P I

Kay Lund of the Department of Phvsioloov and John Louis Nddas of the Oepart*ert of Music were added this

year to the roll of winners of the Phillip and Ruth Hettleman Award. As in the four previous years, the winners were selected from a field of iunior professors nominated by their department chairs for outstanding achievement not only

Professor Pauline Kay Lund, Departnent

the only University-wide award recognizing research or artistic accomplishment. "We are looking for those whose work has really made a contribution t0 their field, whose work suggests they are among the most promising iunior faculty on this campusl' says James W. White, Associate Dean of the Graduate School and administrator of the program.

Lund received her doctorate in gastrointestinal endocrinology from the University of Newcastle upon Tlne in England in 1979, then continued her research with a postdoctoral fellowship at Harvard Medical School. Soon after coming to UNC-CH in 1982, she was introduced to insulin-like growth factors by Judson Van Wyk, Kenan Professor

in

the

Department of Pediatrics, and Joe D'Ercole, also a physician in the pediatrics department.

These growth factors are structurally similar to insulin but perform a very different function, helping to regulate postnatal growth. Their

in bowel growth and repair intrigued Lund as a potential element in

possible role

treat-

ment of various intestinal diseases. That led to her ongoing work with Martin Ulshen, professor in pediatria and director of pediatric gastro enterology at the UNC Hospitals.

Much of Lund's research takes place at the molecular level. She has isolated genes for the insulin-like groWh factors and inserted them into bacteria for mass production. This provides enough raw material to determine the structure of the genes and to figure out which mechanisms switch them on and off. Lund has also begun studies introducing the genes into mice

tV t

of

Physiology, studies insulinJike growth

within their field but across the academic spectrum. A committee of six professors from across campus reviews the nominations and makes recommendations to the chancellor. Lund and Nddas were selected by Chancellor Paul Hardin from five finalists in this year's competition.

The prize, unique among faculty awards, is

H:

factors and gene prccesses.

the edge of her chair. "We can't come close to being able to design things as well as the cell canl'

Lund is also excited by how hypotheses lead to experiments which in turn lead to new hypotheses in a continuing cycle of discovery.

But the process is not always easy. "l lose sleep about my researchl' she laughs. "l will spend a lot of time awake at night thinking about research. I actually get some of my best ideas thenl' The frustration of experiments failing to prove the researcher's hypothesis-which

Lund estimates may happen 8 times out of 10-can quickly erode the idealism that brings many into science. For Lund, that frustration is balanced by teaching, which she always finds

The detective's nose that helps track down and recover lost music also serves Nddas well in another important area of his research: the historical context of music. Solving mysteries of medieval music such as how and why music from Northern Europe spread so rapidly through Italy in the late l4th century 0r where the lost native ltalian music of the early-lSth century went depends on unraveling many strands. To do that, Nddas maintains that musicologists need to use all they can from other disciplines.

They must also be alert for clues in unexpected form, information that may have been consid-

rewarding and enjoyable. Also helping her through

the inevitable setbacks is the knowledge that her research may one day help us understand and even cure diseases like neonatal gastro enteritis, a major killer of babies in North

Professor John Louis Nhdas of the Department of Music is recovering music lost

Carolina.

Like Lund in physiology, Nddas in musicology has interests that range far across his field.

An assistant professor at UNC-CH since 1985,

his work is unified by the theme of the transmission of music in ltaly in the later Middle Ages. Rather than limiting his research, this theme serves as a springboard to launch Nddas

in

many directions.

One course he follows is manuscript recovery. He and coresearcher Agostonino Ziino recently published The Lucca Codex, the result of painstaking reassembly of a lSth-century anthology of songs. The volume had been dismembered a century after its compilation, its notation meaningless to musicians of the day, and the parchment pages reused as covers for notarial documents. A current project uses

before Colunbus landed

in America. ered irrelevant a generation ago. "l find historical context more than a distractionl' he explains, "l find it a responsibilityi' Understanding the manuscript sources is not enough for Nddas. The culmination of his

will be the performance of the music he now works to recover. In 1992, while present research

America celebrates Columbus' iourney, Florence will honor eminent art patron Lorenzo de' Medici on the 500th anniversary of his death.

Nddas hopes to contribute to the festivities with the first public performance in more than

of the resulting overexpression or underexpression of the growth factors. Lund's studies have revealed that a single insulin-like growth factor gene results in at least four products, each with different functions. "What never ceases t0 amaze me is how absolutely simple and elegant the body is in terms of these processes of reg-

what Nddas calls "the wizardry of ultraviolet

it is rewarding "because we'll actually recover music that would have disappeared

five centuries of the music which the young Lorenzo heard while growing up. As Nddas says, "That will be the moment in which we see it all come to lifel' These two Hettleman Award winners are much more alike than their disparate fields would suggest. Not only do they share an excitement about their research which quickly engages others, but both also see themselves

ulation and gene expressionl' she says from

foreverl'

as detectives deciphering complex codes. More-

to analyze the

consequences for bowel growth

photography" to recover another collection that

went the same way, recycled to list the properties of the Church of San Lorenzo in Florence.

Although the work is often painstaking, Nddas says

f,

,I Reports ]lDwTy

A.V

n.s

a condition known as reflux esophagitis. If left untreated, the flow of acid can cause damage.

"Most researchl' 0rlando notes, "has been on acid as the bad guy, and getting rid of gastric acid secretion as the major way of treating this condition. While this approach has been successful, it is not without risk. Risks associated with ablation of acid secretion include an increased risk of enteric infection such as focused

salmonella, increased production of potential carcinogens by bacteria overgrowing the stomach and increased risk of gastric carcinoid tumor

over, they each approach the central puzzle of their research from many directions. And probably in great part because of these similarities, both are breaking new ground in their

fields.

r

Corlorate Cooperadon

Il ESEARCH at UNC-CH is not secluded I( within the well-tended confines of camI\pur. Even rne mosr Dasrc researcn can work its way into the commercial sphere. When that happens, all benefit: the University, industry and society at large. Professors Roy 0rlando of the School of Medicine and Maurice Brookhart of the Department of Chemistry each have

work in their labs that caught the attention of major corporations.

Orlando and coinvestigator Dr. Nelia Tobey have studied the problem of acid injury to the lining of the esophagus for a decade, with technical assistance in recent years from medical school students Virginia Schreiner, Brian Hamilton and John Brockington. In perhaps 10 percent of the U.S. population, the lower

due to hypergastrinemial' Orlando's research suggested an alternative way that the esophageal lining could be pro tected against the acid without actually reducing acid secretion or its activity within the esophagus. This research, supported in part by a

grant from the National [nstitutes of Health, focused on strengthening the lining's own epithelial defense against acid. After initial studies with a line of chemicals suggested that such an approach would work, Orlando contacted a pharmaceutical firm for support in further pursuing the idea. With the corporate

ment of reflux esophagitis

to close properly,

used in production of plastics. Since it produces nearly two billion pounds of one particular intermediate every year, the company as well as the University would benefit from licensing should the process prove economically competitive. But even if there is no licensed production, the University has already benefited from the grant funds and student support provided by the companies. Notes Brookhart, "[n these lean times, that's a real plusl' Brookhart also sees advantages to those outside the University and the licensing corporations. "lf you want to talk about society

which would otherwise have remained no more than an idea.

As in Orlando's medical lab, basic research in Brookhart's chemistry lab made possible projects that hold potential for practical appli-

new technologyl' These projects have attracted corporate attention. One company is inhigued by the development of a cobalt catalyst system which is extremely stable. Such a catalyst opens the door for production of new polymers with special features such as high but very narrow molecular weights and incorporation of reactive

as

Major chemical manulacturers are interested

in

the production pro-

cess used

lo obtdin the

sanple of polyners Professor Maurice

Brookhart holds in his hand.

cooperative efforts between the University and industry could provide them with a choice

doing the fundamental science to figure out the reaction mechanisms, exactly how the catalysts worked. This is an ideal situation where basic 'university-style' research can point the way to

allowing stomach acid to frequently bathe the tissue lining the esophagus. These prolonged acid baths cause inflammation of the esophagus,

at dimerizing functionalized olefins. These dimers are precursors to polymer intermediates

will become available.

catalyst chemistry with Sylviane SaboEtienne.

'All the [current] work originated from a fundamental point of viewl' he says. "lf anything practical arises from this, it witl be a result of

esophageal sphincter fails

underwriting research in the rhodium catalyst system, which promises to be incredibly efficient

This is particularly important for the many who have this chronic condition and may need medication for extended periods of time. The

alyst chemistry with Tony Volpe and rhodium

reflux esophagitis.

license to the process for which the University has a patent pending. A second corporation is

lab enthusiastically endorsing this approach, a contract was developed to fund the research for another three years.

If the supported research achieves its goal, a new and potentially safer agent for the treat-

cation. A polymerization reaction discovered by research associate Greg Schmidt in 1984-85 led Brookhart to recent developments in cobalt cat-

Professor Roy )rlando and co-researcher Professor Nelia Tobey investigate alternative treatnent for

groups into polymers such as polyethylene. The company is supporting research for the next three years and has an option to acquire a

a wholel' he says, "these kinds of arrangements really accelerate getting s0mething you've discovered to the point where it might be practical technologyl' Licensing, administered by a cooperative venture among UNC-CH, North Carolina State University and Duke University called the Tliangle Universities Licensing Consortium (TULC0), provides the cooperation between academia and businesses to take ideas from experiments in the lab to products on the shelf.

The protection offered by a patent encourages industries to risk the large investments needed

to put inventions into practice. "The system here really works well in terms of facilitating the transfer of basic fundamental ideas to the point where an industry will support your research 0r agree to license. Without TULCO and the Patent Committeel' says Brookhart, "nothing would happeni' r in this article is suppoiled in part W appruxinately $470,909 from the National lnstilutes of Health.

Roy Orlando's research discusyd

in this ailicle is supported in part by approxinately $272,282 hon the Natjonal Science Maurice Brookhart's research discussed Foundation

E.A.V.O

Where Theret$ Smoke Researchers

Monilor Passive Smoking in Infants

by Ltra Blancett

HARON, a new mother, stays at her rural Norttr Carolina home to talie care of her \)infunt. Most of the day she tends to her 6-week-old child's needs, but when she has a

ti^

moment to relax, she takes a well-deserved break to watch television while the baby naps next to her in the playpen. She also smokes a cigarette.

While this action may seem like an integral and innocent part of a relaxing break to her, a large team of UNC-CH faculty and supporting staff have reason t0 attempt to reduce infants' exposure to tobacco smoke by altering similar situations. Researchers Robert Greenberg, Karl Bauman, Frank Loda, Barbara Boat, Victor Strecher, Robert Chapman, Floyd Denny, Mary

Glenn Fowler and Helen Stedman responded to a request for applications from the National Heart, Lung and Blood Institute at the National Institutes of Health for a proiect that would study ways to lower the frequency of chronic respiratory disease. The team decided that one way to prevent chronic respiratory ailments in adults might be to reduce chronic respiratory problems in children. There is, however, precious little modern science can do to prevent most

childhood respiratory illnesses. "lt is very dif' ficult to keep children from being exposed to respiratory viruses, the leading cause of respi' ratory illness in children, and there are no vaccines to prevent the most common illnessesl' says Greenberg, the project's principal investigator and a former researcher in the Department of Pediatrics at UNC-CH. ln looking for factors that could be con' trolled, the researchers focused on tobacco smoke.

"Tobacco smoke exposurel' says Greenberg, "seemed to be the only thing that was reason-

ably well+tablished by other investigators as a risk factor for lower respiratory illness in infants, and a risk factor that might be reducedl' The research team designed a study that involved direct intervention into the lives of families and their newborns. Instead of asking parents to stop smoking altogether, the study

E

z

o

9

This North Carolina nother smokes a cigarette near her infant during a daltine break from her routine.

Resurchers at UNC-CH hope to determine how dangerous second'hand snoke is to infants.

aimed at educating the child's main caretakerusually the mother-about the hazards of exposure to tobacco smoke, and then giving her the tools to help lower the infant's exposure t0 tobacco smoke. "This was not an active anti' smoking campaignl' says Loda, a pediatrician

and coinvestigator in the proiect. 'Adults certainly are aware of all the reasons to stop smoking for their own health, and that hasn't stopped them, so we focused on keeping the infant away from tobacco smokel'

The obvious solution seems to be that parents should stay away from their infants when smoking and ask others to smoke elsewhere or to stop smoking. Many other factors are involved, however. "0ne smokes in social situationsl' says Greenberg, "and smoking is an ingrained pattern in many people's lives. To tell someone that they should not smoke in a certain place or that their baby should not be there, is a significant requestl'

E

N.II

Study Aims and Methods Parents may often put aside protecting their own health, but seem to be very aware of their infant's health during the first year of its life, according to the researchers. This first year also seems to be when the respiratory ill effects of passive smoking are greatest. Thus the researchers concentrated on thrs first year for their study. Designed in the same rigorous

Lodat 'Adults certainly are aware of all the rcasons to stop snoking for theft own health, and that hasn't stopped them, so we locused on keeping the infant away fron tobacco smoke."

manner as a randomized, controlled clinical drug trial, the study enrolled approximately 1200 infants born to Chatham and Alamance County residents at University of North Carolina Hospitals, Alamance Memorial Hospital and Alamance County Hospital. Regardless of whether their parents smoked, the infants were randomly assigned t0 two groups, an intervention group and a control group that did not receive

any intervention.

Study enrollers approached mothers soon

=

after the birth of their children and asked if they would consent t0 partrcipate in a study of ways to keep infants healthy. fuo weeks after this first meeting, a data collector visits the home and gathers information on smoking

) Greenberg: "Snoking is an ingrained pattern in many people's lives. To tell soneone they should not smoke around their baby is a significant request."

habits, demographics, risk factors for respiratory

illness and collects infant urine to be tested for cotinine, a metabolite of nicotine that reveals tobacco smoke absorption. When the infant is 3 weeks old, a public health nurse visits the homes of those in the intervention group t0 discuss the hazards of passive smoking and to

help the primary caretaker, most often the mother, develop strategies for keeping the child away from tobacco smoke. The nurse returns 3 times during the child's first year, at 6, i4 and 22 weeks, each time helping the mother cope

with passive smoking.

Durrng the year, t00, a data collector visits the homes of both the intervention group and the control group, taking urine samples from the child for cotinine testing, and asking the mother to detail the activities of a typical day and weekend in terms of possible exposure t0 smoke. The researchers chose to use both personal interview and biochemical measures to maximize the reliability of therr statistics. "lnterview and biochemical measures have different sources of error;' says Bauman, a professor in the Health Behavior/Heath Education department and an expert on addictive behaviors. "lt is desirable to have both. Moreover, smoke around the baby and smoke absorption are conceptually distinct variables in the causal chain leading to respiratory illnessi'

Indivldualized Behavior Modlfication With all the nurse and data collector visits, all the tests, the study obviously required a great

Boat:

'?

was inportant for

the nother to pick a solution

to

passive snoking that she felt she could cany out. lle wanted to create a win situation for her and to reinforce

that behavior."

Shecher: "Rather than focus on the health

consequences

of passive smoking, we tried Io nake the mothers nore confident about their feelings of contrcl over passive snoking."

Bauman: "The progran was guided by several prominent behavioral science theories, and it was designed for pnctial application in the nany different types of fanily situations that night rclate to passive snoking by the infant."

a

deal of cooperation from the family. Part of the reason for the family's cooperation might stem from the individualized approach to intervention.

"Rather than focus on the health consequences of passive smoking, we tried to make [the mothersl more confident about their feelings of

control over passive smokingl' says Strecher, a professor in the Health Behavior/Health Education department. To do this, each family's problems and issues with smoking had to be addressed. "The program was guided by several prominent behavioral science theoriesl' says Bauman, "and it was designed for practical application in the many different types of family situations that might relate to passive smoking by the infantl' Using the work of behavioral psychologist Albert Bandura, the nurses

part in developing tools for the nurses. The team created a "Smoke Scoutl' a small green elf that appears on the small stand-up cardboard displap meant for the baby's dresser. 'Any smoke here?" reads Boat from the display, "Smoke Scout says clear the airl' The Smoke Scout and a "Thank You for Not Smoking: Baby Living Here" sign served as a nonthreatening request to keep smoke away from infants. Thus

the mother did not have to confront the smoker directty if she did not want to-the signs could be conspicuousty placed to do the work for her.

While these materials were designed to convey a message for the mother, she had to confront hypothetical situations and formulate

helped mothers find areas that

they had control over. "ln other wordsl' says Strecher, "you don't put the subiects in a high risk situation right away, you gradually desensitize them by taking them through lower, easier risk situationsl' Nurses would first ask the mother what she thought the difficulties were in maintaining a smokefree environment. answeredl' says Strecher,

"lf

A worlsheet gave the mother and nurse an opportunity to work together, moving from general questions about where one might encounter smoke, to very specific situations in which the mother was asked to choose a solution to passive smoking. By confronting a fictional situation and thinking about an appropriate solution, the mother could try out new methods of making her wishes known in a supportive environment. This exercise was designed to help mothers gain confidence in their ability to protect their child's health-a confidence that would transfer to other areas where she might encounter conflict. "lt was important for the mother to pick a solution to passive smoking that she felt she could carry outl'says Boat.

"We wanted to create a win situation for her and to reinforce that behaviorl' The more difficult the task, the greater the mothers' burden to change others' behavior around their infants. "When it looked like the burden was quite heavyl' says Greenberg, "the nurse would suggest that other family members be present at her next home visitl' Often, however, the mother continued to bear the responsibility. "That's the reality,' says Greenberg. Reality is, of course, what the team wanted to test

she

"'Well, my husband is a big difficulty, and so is my motherin-law, then we would say, 'Let's not deal with them right nowi" Instead, the nurse practitioners would begin with those things

the mother felt she could con-

their intervention against. An efficacy trial would have tested whether the intervention works under ideal conditions, while an effectiveness trial tests whether the intervention worls under the conditions for which

lnlants nay be uposed to snoke fron a variety of sources. Using data fron the \84-infanl pilot study, the three largest circles depict the three najor sources of passive snoke; the

trol, because their outcome

was intersecting areas reveal the percentages of infants who were uposed to snoke from nore than one area. Because of rounding, percentages outside circles may not equal enctly the less risky. The mother may sun of their rcspective components within circles. harr answered, "l could open a it is designed. "We didn't window to let more fresh air choose just mothers whom we inl' According to Strecher, thought were willing to carry out the intersimply opening a window may not have much vention. All healthy babies born in our study effect on clearing the air of smoke, but, he

"it's a positive step. In the four visits, we really tried to start easy and gradually desensitize the mother so that they would bite off a little more each timel' says,

Pracdcal

lhrk

Atd Ghange

As part of the home visits, the nurses brought a workbook and worlsheets, visual aids and several items that could be placed about the house as a reminder of the study's aims. "The materials were a result of hours and hours of asking ourselves, 'What's the best way to raise consciousness about passive smoking?]" says Barbara Boat, a child psychologist whq together with Mary Glenn Fowler, played an important

solutions so that she could gain the confidence necessary to put out her own message. A manual brought by the nurse debunked several myths that surround passive smoking as well as out-

lined several solutions. One, for example, states that only smoke blown in the baby's face constitutes passive smoking; the fact is, according to the booklet, "Smoke doesn't even have to be seen or smelled to be harmfull' Armed with these booklets, the nurses functioned as educators, giving the mother facts that she could use to help her eliminate passive smoking.

According to Boat, the booklet was very carefully constructed s0 as to move from general facts to very specific questions pertaining only to the mother's child.

communities were eligible, with all their varied personal and family characteristics. We wanted

to see if this intervention would work in

a

realistic community settingl' While the researchers continue to analyze data, they hope that they have found a method

for helping keep infants healthy. Perhaps their intervention methods will provide for a new community setting in which children will breathe cleaner

Resarch disussed

inately

1403,313

Institute

in

lnn

air.

!

lhis aflicle is suppond in full @ apnxthe National Health, Lung and Blod

D.E.A.V.O.n

Blood Relations Studying Sickle Cell Mutual-Help Groups

by Scott Lowry

E expect to face an occasional challenge

in our daily lives, and even welcome the change from our routine. But for the 50,000 or so Americans who have sickle cell disease (SCD), leading a normal life is a daily challenge. With medical science still unable to cure the condition and only partiatly successful at treating the symptoms, those who have this inherited blood disorder must overcome not only anemia-induced fatigue and progressive degeneration of bones and organs but also attacls of debilitating pain that strike when damaged red blood cells block circulation to large areas of the body. Although some cannot meet the challenge, many of those with SCD manage to adapt, even excel.

"How do these folls cope?" asls Kermit D. Nash, professor in the UNC-CH School of Social Work. "What kind of support system do they have that enables them to cope, t0 master their environment and life?" He began looking

for answers in 1972 while serving as director

of Psychiatric Services at Yale Medical School, when a friend took him to a sickle cell educational presentation. Upon coming to UNC-CH from Seattle in 1983, Nash immediately talked with the director of Social Work at UNC Hospitals about working half-days \{ith the UNC Comprehensive Sickle Cell Program. Shortly after he began, Dr. Thomas Kinney of Duke University Medical Center and Linda Hails, Social Worker with the UNC Comprehensive Sickle Cell Program, asked Nash t0 join them in developing a statewide consortium under a Special Project of Regional and National Significance grant. This collaborative effort between

the two schools, funded by a threeyear grant of $269,681 from the Genetic Services Branch of the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, demonstrated the impact of multiple psychosocial resources on children and adolescents with SCD. His work with groups across the state prompted Nash to seek support for a nationwide project investigating the impact of

While office nanagu Betty Cole prcparcs infornation for mailing, Professor Kermit Nash and Research Scientist Kathryn Kramer discuss their work on sickle cell disease nutual-help groups.

SCD mutual-support groups on members.

The study continues Nash's search to understand the support systems SCD patients use t0 overcome the effects of the disease. One

of four current major prolects of the Psycho social Research Division of the Duke University Comprehensive Sickle Cell Center (a collaborative effort between UNC-CH and Duke), it is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health. This financial support allows investigators to assemble a wealth of information from group members and leaders about their experiences

with SCD mutual-help groups,

information which can help improve the quality

of life for those with sickle cell disease.

To complement his psychosocial research background, Nash recruited Dr. Kathryn D. Kramer

to the School of Social Work as research scientist for the project. A specialist in research methodology, she provides the link between theory and practice, having developed two sets of questionnaires used in the first phase of the research, and is now analyzing the 1990 data.

"This is a rich data setl' she says. "We have information from 57 groups across 13 states, mostly about demographics, size and member satisfactionl'

16

Eclplng Dlcnbcrr Eelp Each 0ther

manipulate groups as

so

in experimental

situations,

it is impossible to compare them to a con-

hensive list

of SCD mutual-help groups, has

reached the stage in which statistical analysis can be applied to data gleaned from the questionnaires; correlation and regression analysis will show how different variables relate to the project's central concerns of group longevity and member satisfaction.

The project's second phase will expand in

The two questionnaires target two different populations within the sellhelp groups: leaders and individual members. The questionnaire asls leaders to provide information on such things as group size and composition, degree of involvement by health care professionals,

trol group that could have been isolated from

Ieadership, organization, services and behavior expected of group members. The questionnaire

So the researchers employ observation rather than experimental modification of variables to learn about the interplay between groups and

a number of directions. The longitudinal study of individual members will continue with revised

members.

with a subset of 100 people who are group leaders or long-standing members to study the

for individual members is longer, asking not only for their perspectives on the group but also for their own experiences with SCD and its impact on family and friends; their attitudes and expectations; other groups they belong to and other sources of available support.

Nash and Kramer pose two major questions that provide direction for their research. What factors relate to how long individual groups exist? And what variables are associated with

outside variables. Kramer says that many self-help researchers believe that traditional experimental methods would be inappropriate even if practical because modification by the researchers would change the very processes that they are studying.

In the Long Run

how satisfied members are with their group?

Nash and Kramer believe that the usual crosssectional approach in social science research is inadequate, so they committed t0 a longitudinal study of at least five years duration rather than the more common two or three years. Instead

The answers will help organizers and leaders

of taking only a snapshot of SCD self-help

set up groups best suited to meet members'

groups, Nash and Kramer are in effect producing a motion picture. By following subjects across this more extensive period, they will be able to develop an understanding of the life cycle of these groups, finding what characteristics

needs.

As they work toward the answers, the researchers have overcome a series of difficulties, some of which they have turned to advantage.

Because there was absolutely

no information

available on selthelp groups for SCD patients and their families and friends, they had to begin with the fundamentals, finding these groups across the nation. Nash soon realized that their growing list could be invaluable to patients who move and wish to find a group near their new home or to those who wish to form a new group and want guidance from experienced organizers. The resulting National Sickle Cell Mutual Help Directory has proven

quite popular. Not only does the Psychosocial Research Division fill frequent requests for copies, but, notes Nash, "Whenever we go to a conference, we cart them along. Everything else may remain, but those directories gol' An updated edition of the directory with listings for nearly 80 groups nationwide, is planned for early this year.

Another challenge was research methodology.

Kramer explains that the preferred approach in the social sciences is to randomly assign subjects t0 either a control group 0r to experimental groups. Researchers then manipulate variables within the experimental groups-the size of the group, for instance, 0r the types of interactions between members-and compare the groups to

the control group to see whether the changed inputs are associated with changed outcomes in the experimental groups. Such control is not feasible in Nash's project. Those with SCD cannot be randomly assigned: they decide themselves which group to ioin, or even whether to join a group at all. And researchers cannot

and events are most likely to be associated with groups at various stages in their histories.

Kramer suggests, for instance, that younger groups may have more difficulty staying organized, tending to disband for a few months and then return with new leaders. The knowledge learned from this study could prove invaluable

in helping groups

anticipate and overcome

problems.

Indeed, Nash places primary importance

on helping the community beyond the UNC-CH campus instead of merely gathering information to share with other academics at conferences.

The study is particularly exciting because, he says, "We will be better able to tell whether self-help groups-and which kinds of these groups-make a difference. The implications for some of this would be great: What kinds of things to avoid in setting up a group or what kinds of things are helpful to the groupl' Adds Kramer, "[f it's very clear, for example, that groups of less than l0 appear to be better serving the needs of the members, then that's the kind of information we want to share with other self-help groupsl' Tlvo more questionnaire surveys, each a refinement of its predecessor, are planned during the remainder of the fiveyear grant. As Kramer points out, the length of the study has permitted progress from establishing a foundation of d* scriptive, qualitative research to planning for future grant development using more traditional quantitative analysis. Thus the project, which began by assembling the nation's first compre

questionnaires. Phone interviews are planned

group-formation process. The focus will broaden to include not only groups exclusively for adult patients but also those for parents of children with SCD. Robert Devellis, assistant director of

the Rehabilitation Program at the UNC School of Medicine, will join in a case history study of group formation, and Thomas R. Konrad, director of the Program on Health Professions at the Health Services Research Center of the UNC School of Medicine, will map locations of SCD self-help groups against health services data, population data and population characteristics of the areas in which groups are located.

Halfway through the project, Nash is already looking ahead. "We're into our third year of

the five year study, and already thinking about continuing for another fivel' he says. "Being able to follow the groups for l0 years would let us answer some more specific questionsl' Kramer adds that they might do so by using other methods such as on-site observation of groups, in-depth interviews and psychological and physical assessments of health status. Information from these additional projects could provide insight into the effects of self-help groups on member health, but Nash and Kramer consider such ambitions beyond the reach of the present program. They are instead interested in acquiring baseline information on characteristics of groups and group leaders as well as on characteristics, attitudes and feelings of group members.

A Dlodel for All Chronlc Condlfionr Underlying this interest is the realization that attitudes and feelings are intertwined with a person's state of health-what psychosocial theorists call an ecological conceptualization of the individual. As Kramer explains, we each have physiological, psychological and social dimensions. Those dimensions interact not only

with each other but also with the environment to determine our state at any moment. "How I feel physiologicallyi' she says, "can influence me emotionally today, and what is going on with my finances, or how much support I'm

NDE

[tvtng wlth Slckle Gell Dlccasc "

f I I

F you healthy people worked as hard as we have to just to lead an ordinary lifel' confides a sickle cell disease (SCD) selthelp group member to a visitor, "you could do anythingl' Witness David Phoenix and Tacey McCaulry. Phoenix, an associate professor in the health care management program of the Walker College of Business at Appalachian State University,

in public health at UNC-CH more than a decade as a social worker. McCauley recently entered the University six years after graduating from high school and joining the iob force in his native Chapel Hill.

McCauley's irrepressible humor and Phoenix's quiet intensity are different uprusions of the energy that animates so many who have overcome sickle cell disease.

What are these two and the other 50,000 or so Americans with sickle cell up against? The jagged red blood cells (see photo back cover) which give the disease its name are responsible for the host of problems associated with SCD. When these corpuscles clog veins and arteries, the patient suffers not only extreme pain, but also cumulative tissue and organ damage. The blood cells themselves are fragile, surviving only one t0 two weeks instead of the usual four months. And the spleen, which rids the blood of inlading microbes as well as dead corpuscles, dies from overwork within the first few years of life, causing vulnerability to infections.

AII ethnic groups arc subiect to SCD, Phoenix explains. "Populations that live in earned a doctorate

in l98l after

tropical or near{ropical conditions along the Mediterranean coast of both Northern Africa and Southern Europe tend to have the disease. It occurs in Greeks and Cypriots, and in many of the Arab populations. lt's in the gene pool of people from Southeast Asia and populalions of the subtropical lndian areas and the Veddas [of Ceylonl. The criterion for whether the disease is in the gene pool is whether the Anopheles mosquito, the carrier of malaria, was present in the geographic areas that people settled when the gene pool was being establishedl' Phoenix explains that in the United States the disease is most closely associated with blacks because they were the first and largest group of immigrants

who had the disease in their gene pool, but clinics today see the disease with increasing frequency in other ethnic groups such as recent immiqrants from Vietnam and &mbodia.

While there is no one course which the disease follows, the uperiences of Phoenix and McCauley offer typical examples. Phoenix remembers suffering two or three episodes of crippling pain each month from age four to 12.

"But as I moved into my teen years;' he says, "manifestations of the disease decreased to where I'm pretty much symptom-free. 0h, I $ill have the hemoglobin deprivation, lack of energy and sometimes [ow] oxygen uptakel' More serious effects also remain. "l don't want to sound like I'm in perfect healthi' Phoenix

reflects.

"l've had to have my hip replaced

my knee replacedl' McCauley, 20 years

and

younger,

has so far been spared serious joint damage, although attacks of pain and illness struck

regularly throughout his teen years. Both men have refused to let the disease take over their lives, continuing work and school through it all, though McCauley admits to having recently scaled back his workload. "l worked mornings, then I'd go to school, then work again. I went to get my blood drawn one day, and they only got about one drop in five minutes. They said, 'You've got to give up something; so I work .just one job nowi' More than anything else, attitude determines whether a person will be overwhelmed by the disease. "l was lucky because no one lurned me into a sick personl' Phoenix says about his childhood. "l should give all the credit for

usual approaches prove inadequate. Because medical science today cannot cure SCD and can treat the symptoms with only limited suc. cess, taking advantage of alternatives offered by the psychologrcal and social dimensions is

critical for improving quality of life and daily function for patients.

Alternative approaches have gained acceptance throughout the sickle cell research community, in sharp contrast to attitudes Nash encountered when he started to study SCD during the '70s. "There was very little interest by research scientists in psychosociall' he remembers about presentations at SCD conferences then. "They would lean over t0 me and say, 'Look, now don't take it personally,

I I I

I i1. '.1

Tracey McCauley, a UNC-CH student, and David Phoenix, a UNC"CH alunnus, say thal sickle cell disease not only has not kept them from accomplkhing their goals in life, but that helping others

with the disease benefils the helper as well. whatever I've become to my parents. They always encouraged me to excel and never accept my

illness as a fault, and never allowed me to use it as an excusel' That family-centered support is still important to him, and has expanded over the years with marriage and children.

But sometimes family is not enough. At times it may seem that only someone else who has the disease can understand and help. Many with SCD have found such support in mutualhelp groups like the one that meets every other month at UNC Hospitals in Chapel Hill. Most would agree with McCauley's assessment that the greatest benefit is having someone to talk to and to help: "l used to think I was the only one with sickle cell until the group started meetingi' A high school senior from Fayettwille, Xavier Henderson explains, "lt helps you build up your confldence [when you] realize that other people have the same problems. [The group] gives you information so you know how to handle [prob lems]. I think we all help each otherl' Helping each other is the unwritten credo of lhe mutual-help group. With such support, sickle cell patients and their families find the strengh to o\ercome not just the disease, but common misconceptions. People with SCD do not want sympathy; they want a chance. "Just because we have an illness doesn't mean we can't do itl' admonishes McCauley. "Give us a shot; we can

do more than you

getting from my family and friends, can all come together to influence how I act. It's a dynamic system of transactions or interactions that influence the outcomel' Illness is itself a dynamic component of these ever-changing interactions, and so each personal dimension provides potential means of treatment when the

thinkl'

I

but I'm leaving the room. I don't know anything you're talking about and I don't want to hear iti They were just looking for a cure. Now I'm noticing a complete turnaround; physicians stay in the room when we're presenting this stuff. I think it communicates a growing concern for the total person, rather than just looking at the person as a biological entity t0 be fixedl' As medical advances redefine many onceterminal diseases as chronic, Nash believes that psychosocial models of treatment can only become more widely embraced. Pleased with changing attitudes among SCD researchers, he regrets that those in many other fields are slow to follow suit. About a year ago at an international conference on Cooley's Anemia, Nash watched the physicians leave the r00m when the psychosocial discussion began. "l realized they're about where sickle cell was 12 or 15 years agol' he observes. "This just happens to be srckle cell that we're working with, but what we're doing can be modeling for any chronic

conditionl'

I

-Sonserae M. Snith contributed to this article

in this article is suppofted in full by approxinately $173,890 fron the Aeoetic Seruices Branch 0f the Matemal Research described

and Child Health Bureau.

E.II

.D.E.A.V

Out of the Rat Race Changing an Infant Rat's Response

by Dottie

to

Stress

llorn

of energy that can be readily used, [enabling] you t[o respond]-you can run away 0r you can stand and fight. Thus, the release of corticosterone can be very adaptivei' The HPA system responds to psychological as well as physical stress, and says Noonan, "We're interested in the psychological variablesl' Noonan's focus on how the HPA axis

in infancy is important humans, a disregulated HPA axis, with or without environmental stress, may result becomes regulated

because,

.r@*ryr'

Having just separated this l04ayold rat pup fron its nother, Linda Noonan, research assistant protessor of psychiatry preparcs to place it in an incubator. After 20 minutes, Noonan will measure the pup's physiological reaction to the sepantion.

in

in the release of too much cortisol. Research with animal models as well as some data from humans, according to Noonan, suggests that a higher than average amount of cortisol released over a lifetime may damage certain memory brain cells. 0veractivity of the HPA axis has been linked with Alzheimer's disease in this regard, says Noonan. In addition, she says, "excessive secretion of cortisol is extremely stressful to the cardiovascular system" and may be implicated in such stress-related disorders as heart attack and stroke.

Overactivity of the HPA axis is also considered a marker for diagnosing ma.ior depression in adults. Because the HPA axis works differently in children, however, the test measuring its

functioning in adults cannot be used reliably

r I I

N the future. testins children's hormonal levels ,uu ullo* clinicians to determine whether a child is likely to develop depression

or stress-related illness as an adult. With this

in mind, Linda Noonan, research assistant professor of psychiatry, studies rats to learn goal

more about how the hypothalamopituitary-adrenal (HPA) axis works.

Noonan's interest lies

in the role of

the

environment-particularly the family-in regulating physiology and, in particular, shaping brain development. "When you're youngl' says Noonan, "the environment that you grow up in plays a great role in the way your brain develops. There are many physiological functions regulated by the caretaker, usually the mother,

early in life-growth-hormone release and heart-

rate regulation are examplesi' In studying the effect of the environment on brain development, Noonan uses the HPA axis as a model system (see chart page 20).

Noonan explains that the HPA axis-which consists of numerous hormones released from the brain, pituitary and adrenal glands-enables

an organism to respond to stress. When an animal experiences a stressful situation, a chain reaction of hormones is set into play that results in the release of a hormone called

in rats. (ln humans, this hormone is called cortisol.) "Corticosterone prepares the organism metabolically to make a response in a stressful situation. For instance, if you are

corticosterone

physically threatened, the HPA axis causes protein and fat to be converted to glucose, a source

with children. Noonan aims to discover which hormones are good measures for indicating

in the HPA axis in children. By finding such a measure, children at risk for major depression as adults could be identified.

Noonan's research, funded by the National Institutes of Mental Health, the Foundation of changes

Hope for the Tleatment and Prevention of Mental Illness and the National Alliance for Research in Schizophrenia and Affective Disorders, began with some knowledge of the infanls HPA axis functioning. According to Noonan, the rat HPA

axis in the first 2 weeks of life differs from the adults' in that it is suppressed and does not respond to stress. Says Noonan, "The release of corticosterone in these rat pups would be detrimental because it would take energy away

RS

from growth and development, which is their main focus right then, and ready their bodies for a defense reaction they can't

oxytocin and returned to the mother, the repeatedly separated pups showed significantly lower levels of serum corticosterone than the undisturbed pups. Thus, says Noonan, repeated separation causes the

make-

they're immobile, they're blind, they're deaf -there's not too much they can dol' In addition, according to Noonan, the pups do not need to defend themselves: "These babies are in a nest; the mother takes care of them completely. They do not respond to stress as long as they're in their normal environment, and to a rat pup, the mother is the environmentl' Noonan's research focuses

infant HPA axis to be less responsive to oxytocin.

In addition,

says Noonan, basal levels

of corticosterone are lower in the repeatedly separated pups. The levels of serum corticosterone following injection with saline are taken to be basal levels. Whether separated 0r returned to the mother after saline injection,

on what happens when the pups are removed

from the mother.

repeatedly separated pups showed lower levels

of serum corticosterone than undisturbed

Separation Activatec Stress Responre

period in brain development, when the brain is maximally responsive to an environmental manipulationl' The HPA axis is susceptible during this period, says Noonan, to a repeated patterning. As we have seen, when the pup is separated from the mother, "The HPA axis becomes more sensitive; so that now, if you present that rat pup with a stress, the system

Noonan first discovered that, although a puy's HPA axis was suppressed, separation from the mother was a factor that made the infant's HPA axis respond to the same hormones that stimulate the HPA axis of adult rats. When adult rats are injected with oxytocin, the release of corticosterone into the

with infant rat pups 10-12 days old, who, after injection with either saline (as a placebo) or oxytocin, are either placed in

a

warm incubator (acute maternal separation) (non-separated).

Noonan points out that when she separates rat pups in her experiments, the separations are mild exaggerations of what normally happens in a wild rat puy's life, as when a mother leaves the nest to feed. Because the separa-

When separated fron its nother this l)-day-old rat pup experiences strcss. After separations for as little as 20 minutes per day on days 2 through 11 ol its life, a rat pup will exhibit a dininished response to stress throughout its life.

separated, the HPA axis becomes repatterned,

to the mother. Thus, as in the experiment with oxytocin, maternal separation caused the HPA axis to be more responsive.

tions are short, the animals do not get hungry

or debilitated while

separated.

Following acute separation or non-separation, serum levels of corticosterone (levels of corticosterone in the blood) are collected at various time points from l0 to 720 minutes after injection. At nearly every time point, the pups injected with oxytocin and then separated from the mother showed significantly greater levels of serum corticosterone than the pups injected with oxytocin and returned to the mother.

Thus, acute maternal separation stopped the suppression of the HPA axis, making it more responsive

to

hormones.

Noonan repeated the same experiment, using the hormone corticotropin releasing factor (CRF) instead of oxytocin. After the CRF or

saline injection, rat pups 10-12 days old are either separated or returned to the mother for 20, 40, 60 or 120 minutes. At 20 and 40 minutes of separation, the rat pups injected with CRF and separated from the mother showed significantly greater levels of serum corticosterone than rat pups injected with CRF and returned

will respond. As soon as they go back t0 mom and she's maternal with theml' says Noonan, "the axis quickly shuts down and doesn't respond to stressl' When the axis is sensitized and inhibited repeatedly, as when the pups are repeatedly has become geared up and

blood is the end result. Noonan experimented

or returned to their mother

pups.

Noonan explains that her separation of the pups 0n days 2-11 occurs during a "sensitive

Repeated Separation Lowers Range of Stress Response

"such that you have lower resting levels of corticosterone and also a diminished corticosterone response to stressl'

Stress Response Change Permanent Noonan next asked whether this down-regulation

After determining that a single maternal separation makes the infant HPA axis more responsive to both oxytocin and CRF, Noonan studied the effects of repeated separation on the axis. She compares two groups of rat pups-those repeatedly separated (separated from the mother for 20 minutes each day from day 2-11) and those remaining undisturbed with the mother from birth. 0n day 12, Noonan injects both groups of pups with either oxy.tocin or saline and then either separates the pups or returns them to the mother for 20, 40, 60 or 120 minutes. In the group in.iected with oxytocin and then separated from the mother, the repeatedly separated pups showed significantly lower levels of serum corticosterone at all time points than the pups who remained undisturbed throughout infancy. Among the pups injected with

of the HPA axis observed in repeatedly separated infants continues into adulthood. Specifically, Noonan predicts that adult rats who have been repeatedly separated as infants will be less responsive to oxytocin and CRF

in

both

stressed and non-stressed conditions than rats

who were undisturbed during infancy. Infant rats are repeatedly separated on days

2-11,

then, except for weaning on day 23, remain undisturbed until adulthood at 90 days of age.

After reaching adulthood, the rats are in,jected with either saline, CRF or oxytocin. Half the rats are returned to their cage; the others, says Noonan, "are acutely stressed by a novel environment for three minutesl' The novel environment stress consists of placing the rat on a platform

in the middle of a wading pool filled with water. Serum levels of corticosterone are determined at 10, 20, 40, 60 or 120 minutes following injection.

vo

EA

:0

R.S

these conditions for 20, 40, 60 prior to blood collectionl'

The f,ypothalamo-Pituitary-lldrenal Axis

adrenal (HPA) axis of adult rats, the brain is the

primary regulator. The hypothalamus, which is part 0f the brain, releases the hormones oxytocin

and separated completely from the mother. As the milk did not change the pup's response, says Noonan, "We know that tactile contact with the mother is the most important characteristic for regulating the infant HPA axisl' Noonan relates this finding to research

and corticotropin releasing factor (CRF), and these, in turn, stimulate the pituitary gland to release the adrenocorticotropic hormone (ACTH).

ACTH causes the adrenal gland (located in the abdominal cavity) to release the hormone corticosterone. Receptors in the brain monitor levels of corticosterone in the blood and when a sufficient supply exists, signal the hypothalamus to stop the release of corticosterone. This is called

done with premature human infants. Researchers have found, she says, "that rf you pick up preemies every day and hold them gently and

loop.

stroke them on the back with a certain pattern of tactile stimulation, they grow faster, they

Noonan explains that although the unitary effect of the HPA axis is the secretion of cor-

have better scores 0n neonatal tests

ticosterone, its multiple levels allow for fine regulation. "lf you want to turn [a system] on and off quickly and have a gradated ability to

of health

and reflexes, they gain more weight, and they get out of the hospital fasterl' Thus, as with the rat pups, tactile contact can influence

release hormones, you need many different levels

of fine tuningi' In addition, says Noonan, "There is some suggestion that certain hormones may be used to stimulate the system for different

120 minutes

Noonan discovered that both the pups given contact and milk and the pups grven contact only showed significantly lower levels of serum corticosterone than pups given oxytocin

Noonan explains that in the hypothalamo-pituitary'

a negative feedback

or

physiological functions. types of stresses, for instance, oxytocin has been associated with a psychological stressl'

Separation or More Care?

Having determined that tactile contact with the mother inhibits the HPA axis, Noonan asks

rJ,l.

whether rt is in fact separation or simply more maternal care that brings about the repeated

\

/c:',.1 )-L -:\ \

ffi,1*

separation effect of decreased response t0 stress. She hypothesizes that "separation is only necessary because it motivates the mother to give the pups more care afterwardsl' Noonan tests this hypothesis with "a model whereby

we have half the litter being separated and the other half remaining undisturbed in the cage. t

\'r/

When we return the separated babies, we take all the babies out, mix them up, and put them all back inl' The mother responds, says Noonan, "by giving maternal care to all the pups, whether they were separated or noti' By comparing the HPA axis parameters of the separated and the

"we'll

By studying the rats injected with saline and returned to the cage, says Noonan, "We've established that repeatedly separated rats have

in a controlled, nonstressful environment will

non-separated pups, says Noonan,

allow memory function to be retained longer

lower basal levels of corticosteronel' ln addition, says Noonan, "when you give the rats a mild stress situation, the ones that have been

What is

able to see whether the inhibiting factor is increased maternal care in the face of having been separated or just more maternal carel' In the future, Noonan's investigations could

repeatedly separated don't respond with increases

Noonan's research next focuses on identifying

in corticosterone as do the ones that do

the specific maternal characteristics that inhibit

not

receive that treatment during infancyl' Although Noonan is in the process of testing the adult

rats after injection with CRF and oxytocin, current data indicate that repeated separation in infancy changes the HPA axis permanently.

0ther researchers have related this finding

to how memory functions and, possibly, Alzheimer's disease in humans. Research shows that once a rat's HPA axis has been downregulated by an early experience, "[the] lower levels of corticosterone throughout the liletime

into old agel' says Noonan.

it

About the Mother?

be

lead to more than the early identification of

corticosterone release. Noonan experiments by injecting previously undisturbed 10-12 day old pups with oxytocin. The pups are then placed

in one of five situations: either they can contact the mother and get milk; they can contact her and attach t0 the nipples, but not get milk (because she is anesthetized); they are separated from the mother, but a tube delivers milk directly to their mouths; they are separated but can smell her; or they are separated completely.

According to Noonan, "pups were placed in

those infants vulnerable to depression 0r stressrelated illnesses as adults. Her research on the aspects of maternal behavior that change the rat pups' physiology could lead to prevention and intervention strategies. Parental counseling

and follow-up of infants might help ensure that babies receive appropriate parental separations and adequate nurturing. Finding the means for such early identification and intervention is Noonan's long{erm goal.

r

Reseani discussed

in

lhis arlicle is supported in pdrl bv apprcx

intatelt $89.366 fran the Nalional lnstihte 0f Mental Health.

Ir's AS Swrpm AS JirAr. 'lfrrnour Nonrn Cenoux.ds coMMTTMENT To cRADUATE woul-D

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To rmln, coNTACT: Dlnrcron or Spscnl PRo;rcrs, lJNrvnnsrrv DrvelopurNr

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