DISEASE PREVENTION AND
CONTROL AMENDMENTS

CDC-1997/04
1/7/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Sworn Agent Designation

Authorize NCHS/CDC to Designate Sworn Agents to Perform Statistical Activities.

Current Law: The Census Bureau is authorized (13 U.S.C. 23) to use temporary staff to assist in performing its statistical activities if these employees are sworn to comply with Census Bureau restrictions on use of information and are subject to sanctions for misuse. The National Center for Health Statistics (NCHS), CDC, has no corresponding authority. NCHS has strong confidentiality protections afforded by Sec. 308(d) of the Public Health Service Act.

Proposal: Authorize NCHS to designate sworn agents to perform exclusively statistical activities authorized by law.

Rationale: NCHS recognizes the importance of maintaining confidentiality protections so that survey respondents can be sure that personal information that they provide for statistical purposes will be maintained in a confidential manner. Given the investment in data collection mechanisms and the value to be derived from maximizing the analytic potential of the data collected, it is important to the health community that NCHS foster the widest possible use of data within the bounds of its commitment to confidentiality.

The Census Bureau has statutory authority to designate special sworn employees subject to the same confidentiality requirements as Census employees to assist in analysis of Census data. A similar model could be used by NCHS. Sworn agents would use the NCHS data only for the purposes for which they were collected and would be allowed access to confidential data files only under tightly restricted conditions to ensure that confidentiality of the data would not be jeopardized. These agents would be subject to the provisions of 308(d) of the Act as well as any penalties for inappropriate disclosure to the same extent as an NCHS employee.

Such an arrangement would expand the range of worthwhile research that could be conducted using NCHS data, would allow researchers to pursue greater analytic linkages between different data sets, and would allow NCHS to work more closely with other agencies to meet their data needs - all of which would result in increased knowledge and benefits to the public. A provision to allow NCHS to designate sworn agents as described above was included in a legislative proposal - the “Statistical Confidentiality Act” - submitted to the Congress in April 1996. The proposal was introduced in the House (H.R. 3924) in the 104th Congress. The proposal would expand and improve the research opportunities available to NCHS data users.

Cost: None.

Additional Information: The provisions requested in this proposal are contained in H.R. 2885, the Statistical Efficiency Act of 1999, under consideration by the 106^th Congress, introduced on September 21, 1999, and which passed the House on October 26, 1999.

CDC-1999/01B
12/7/98

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Breast/Cervical Cancer Prevention -- Percentage Requirements

Revise percentage spending requirements for the National Breast and Cervical Cancer Early Detection and Control Program.

Current Law: Title XV of the PHS Act establishes CDC’s Breast and Cervical Cancer Early Detection Program. The current law requires grantees to spend at least 60 percent of the grant on screening for breast and cervical cancer, referrals for treatment, and assurance of follow-up services and no more than 40 percent of the grant for public information and education, professional education and training, monitoring screening quality and evaluation of activities.

Proposal: Authorize the Secretary to waive the specific percentage requirement for grantees receiving $750,000 or less annually while continuing to require that all activities of this program be carried out.

Rationale: The overall quality and strength of CDC’s Breast and Cervical Cancer Early Detection Program, which currently funds grantees at an average of $2.0 million per program per year, is based in large part on the viability of the grantee’s public health infrastructure. In the context of this program, “infrastructure” means having the capacity to implement, through the existing public health system, the five key components or the program: screening and follow-up, public education, professional education, surveillance, and evaluation. Screening and follow-up benefit uninsured women in the grantee’s jurisdiction; other elements of the program benefit all women in the grantee’s jurisdiction.

The majority of grantees have a fully developed public health infrastructure and are capable of expending 60 percent of their grant funds effectively on screening, referral, and follow-up service to the eligible populations. However, approximately 10 small grantees (Indian Tribes, Tribal Organizations, Territories and a few States which receive less than $750,000 per year) have special circumstances and are unable to expend their grant in accordance with existing percentage spending requirements. Specifically, these small grantees have greater public health infrastructure needs, and smaller populations of uninsured women requiring screening and follow-up. The current 60/40 rule does not allow these grantees, in particular, the flexibility to dedicate the necessary resources to develop their public health infrastructure in order to be able to implement the program over time in an effective manner. For example, these grantees need additional flexibility to recruit appropriate staff, train health providers, implement case and data management systems, conduct public education and outreach to increase participation in screening, and conduct public education and outreach to increase the number of women who participate in screening. By allowing the Secretary to waive the 60/40 rule, these small grantees would have the flexibility to develop the infrastructure they will need in order to meet their screening requirements in the long term and to achieve the objective of promoting the importance of screening to all women and health care providers in their jurisdiction.

CDC would continue to provide TA and monitor grantees. Moreover, through this process, CDC will assist these small grantees in implementing a program that would allow for greater flexibility in setting an appropriate balance between the screening and other infrastructure components in the Program.

Cost: None.

CDC-1999/01D
12/7/98

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Breast/Cervical Cancer Prevention -- Demonstration

Expand the demonstration program authorization for preventive health services grants.

Current Law: Title XV of the PHS Act established CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Section 1509 of this Title permits establishing, a demonstration project, in three states, for essential preventive health services (including blood pressure and cholesterol screening) in addition to breast and cervical cancer screening.

Proposal: Eliminate limitation on the number of states that may participate in demonstration programs.

Rationale: Currently, this demonstration program is the only public health program that specifically targets uninsured and underinsured women aged 50 years and older with health promotion program (nutrition and physical activity) and preventive health services. CDC already has initiated important demonstration projects in three states as allowed by law. The three-state restriction precludes needed testing and evaluation of project variations. By removing the three- state limit in the current authority, it would be possible to test and evaluate the effectiveness of implementing comprehensive preventive services approaches with women in other geographic areas and, in particular, to test and evaluate programs tailored to the health needs of special populations of women.

In currently participating states, the demonstration projects have been integrated effectively into the existing NBCCEDP program at many sites, served more than 3600 women, and identified large numbers of women with abnormal cholesterol or blood pressure levels (almost 90% in one demonstration program). Participating States and local health clinics are highly supportive of developing integrated services approaches, wherein women being screened for breast and cervical cancer also can be screened for blood pressure and cholesterol levels and be offered pertinent information (health education). Preliminary data from the program indicate that integrated approaches of this type offer States vital prevention opportunities within populations that are at very high risk of developing chronic diseases, such as heart disease and diabetes (uninsured or underinsured women aged 50 years and older). Future program activities will be based on evaluations now in process.

Because the current demonstrations are so limited in size, scope, and location, testing and evaluation in sites in additional states is vitally important to the development of model programs. For example, existing programs are not statewide and meet the screening needs of only a small portion of eligible women. Moreover, special populations (Urban Black, American Indian, Asian American women) are not being targeted in the current demonstrations.

In summary, revising the law to remove the limitation on the number of States in which demonstrations can be conducted would permit initiating innovative projects to test and evaluate approach variations, particularly approaches for special populations of women. These additional demonstrations and evaluations would enhance substantially the science base for designing and implementing appropriate screening and intervention programs in the future.

Cost: No funds requested.

CDC-1999/02A
12/7/98

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

National Program of Cancer Registries

Expand the type of organizations eligible to operate State cancer registries.

Current Law: Section 399H of the Public Health Service Act establishes within CDC a national program of cancer registries, and authorizes grants to States to support the operation of the registries. Also, in lieu of making a grant to the State, the law allows for grants or contracts with academic or nonprofit organizations designated by the State to operate the State's registry. The law does not permit grants or contracts with other entities, such as private, for-profit organizations.

Proposal: Remove the restriction that States may designate only academic or nonprofit organizations to operate the States' cancer registries.

Rationale: By allowing only academic or nonprofit organizations to operate the State's registry, the law unnecessarily and unfairly limits the States' options and undercuts their ability to choose the best servicing agent for the registry. In certain cases, States may not have an academic or non-profit organization with the necessary expertise, infrastructure or interest in serving as the designee for cancer registries. In some states, although adequate academics and non-profits may exist, the best choice may be a private, for-profit facility because of the expertise and resources already available to that organization. A large for-profit cancer center, for example, may diagnose and treat the majority of cancer cases in a State and would be the State’s logical designee to operate the cancer registry, yet would be ineligible to play this role because of current federal law. It is important to expand eligibility criteria to include such organizations, permitting States the flexibility to select the best choice for this program. No proprietary or data confidentiality issues have surfaced or are anticipated. Any data ownership issue would be addressed specifically in the agreement between the State and its designees. CDC will provide technical assistance to support the States in this effort.

Cost: None.

CDC-1999/03
1/19/99

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Reauthorize STD-Related Infertility Program

Reauthorize the Infertility and Sexually-Transmitted Disease Program.

Current Law: Section 318A of the Public Health Service Act authorizes activities related to screening, treatment, counseling, and follow-up services related to sexually transmitted diseases (STD) that can cause infertility in women if treatment is not received for the disease.

Proposal: Reauthorize appropriations for the STD-related infertility program for five years.

Rationale: Reauthorization of this program is essential to ensure the continuation of critical STD-related infertility prevention services. STDs are hidden epidemics of tremendous health and economic consequences in the United States. Women and infants bear a disproportionate burden of STD-associated complications. A variety of women’s health problems, including infertility, ectopic pregnancy, and chronic pelvic pain result from unrecognized or untreated STDs.

The STD chlamydia is the most frequently reported infectious disease in the United States (an annual incidence of 4 million cases). When undiagnosed, chlamydia can cause severe, costly reproductive and other health problems. These include both short-and long-term consequences, such as pelvic inflammatory disease (PID), which is the critical link to infertility, and potentially fatal tubal pregnancy. Up to 40% of women with untreated chlamydia will develop PID. Of those with PID, 20% will become infertile. Chlamydia also results in other adverse outcomes. When diagnosed, chlamydia can be easily treated and cured. Conservatively, the reproductive consequences in women result in an estimated annual cost of chlamydia infection in the U.S. of $2.4 billion, $1.7 billion of which is attributable to treatment of preventable, serious after effects in women.

Authorization Level: Such sums as necessary

CDC-1999/03A
1/6/99

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Infertility/STDs – Male Inclusion

Expand the sexually transmitted disease-related infertility program to include males who are not sexual partners of women screened in the program.

Current Law: Section 318A of the Public Health Service Act authorizes a program to address any treatable sexually transmitted disease that can cause infertility in women if treatment is not received for the disease. The activities authorized under the section pertain only to women and their sexual partners.

Proposal: Allow grantees of 318A funding to screen and treat for chlamydia men who are not sexual partners of women served by the program, as long as screening coverage levels in women are not reduced.

Rationale: The intent of Section 318A is to prevent STD-related infertility in women. However, the existing statute undercuts efforts to achieve this overall objective by authorizing related intervention only for females and for males who are sexual partners of women served under the program -- not for other males who may be at risk. Amending the statute to permit grantees to provide intervention activities for males who are not sexual partners would rectify the limitations of the current law. The progress being made against STD-related infertility in women soon will plateau unless previous activities are directed to men more broadly.

Several studies have demonstrated that chlamydia is common among young men and that up to 50% of infected men have no symptoms. The recent availability of highly accurate urine tests for chlamydia now make screening males a feasible intervention to reduce asymptomatic disease in men and importantly, to reduce transmission to women. Studies have documented a 50% male to female transmission rate; that is, one of every two encounters with an infected male results in an infected female. Because the STD-infertility programs have focused on prevention efforts in women, many men with chlamydia are not diagnosed and treated, thus continuing the cycle of infection. Untreated chlamydia in men typically causes urethral infection, but may also result in other complications.

Cost: No funds requested.

CDC-1999/03B
1/19/99

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Infertility/STDs -- Treatment Training

Authorize training about treatment for sexually transmitted disease-related infertility.

Current Law: Section 318A of the Public Health Service Act authorizes activities related to screening, treatment, counseling, and follow-up services related to sexually transmitted diseases that can cause infertility in women if treatment is not received for the disease. The law also authorizes providing training to health care providers in carrying out screening and counseling, but the law is silent regarding the provision of training for health care providers about appropriate treatment.

Proposal: Revise the law to authorize training for health care providers about appropriate treatment for STD-related infertility.

Rationale: Training health care professionals only about screening and counseling for STD- related fertility is inadequate. Including treatment as part of training programs in the medical community is an essential activity.

Expending resources and providing training on screening and counseling activities is pointless if adequate and timely treatment of both infected individuals and their sexual partner does not occur. Once diagnosed, proper treatment is key to controlling further disease transmission, and for women, to averting long-term sequelae. Several surveys of prescribing practices of providers have demonstrated that as many 25% do not use correct anti-microbial therapies, highlighting the need for continued training on appropriate treatment for these common infections. The CDC regularly publishes recommended treatment regimens for all STDs.

Lower genital tract chlamydial and gonococcal infections are easily cured by early and prompt treatment with a short course or single dose of specific antibiotics. However, if not adequately treated, up to 40 % of women infected with chlamydia and gonorrhea develop upper genital tract infections, also called pelvic inflammatory disease (PID). PID is the leading cause of STD- related infertility in women.

Cost: None

CDC-1999/03C
1/19/99

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Infertility/STDs -- Grant Cycle

Revise the grant cycle limitation for the STD-related infertility grant program.

Current Law: Section 318A of the Public Health Service Act authorizes a program of grants to States to address STD-related infertility in women. The law stipulates that grants made under this program may not exceed three years.

Proposal: Revise the statute to eliminate the three-year limitation on the grant.

Rationale: In numerous other State grant programs CDC administers, grants generally are awarded for a period of up to five years, not three. Additionally, in many other cases, the permissible duration of the grant is not specified in statute. For example, the general grant program for STD prevention authorized under Section 318 of the Public Health Service Act does not stipulate a three-year limitation on funds awarded, whereas Section 318A (STD-related infertility) does have such a limitation. From both a program planning and administrative perspective, it is desirable to allow for corresponding grant cycles for the STD and STD-related infertility grant programs.

Cost: No additional costs.

CDC-2000/01
4/20/99

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Reauthorization of the Preventive Health and Health Services Block Grant

Reauthorize the Preventive Health and Health Services Block Grant for an Additional Five Years

Current law: Title XIX, Section 1901 of the Public Health Service Act establishes CDC’s Preventive Health and Health Services Block Grant.

Proposal: Extend the current authorization for an additional five years.

Rationale: The CDC-administered Preventive Health and Health Services Block Grant is a model partnership between the Centers for Disease Control and Prevention, local communities, and state health departments. This mechanism allows CDC to target funds to important public health issues based on the health priorities of local communities and in consultation with state health departments which assure accountability for the funds spent. It is the leading source of funds for injury prevention, dental health, and emergency medical services. The Block Grant program also serves as the primary source of Federal funding to States for health education and risk reduction activities, cholesterol and hypertension screening, cancer prevention, and sex offenses prevention programs. The flexibility of this program allows for targeted, strategic efforts to address specific health problems at the local in a collaborative manner

Authorization Level: Such sums as necessary

Personnel Requirements: 32 FTE

CDC-2000/02
1/18/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Preventing Prostate Cancer

Reauthorize the Preventive Health Measures with Respect to Prostate Cancer.

Current Law: Section 317D of the Public Health Service Act establishes the CDC’s Preventive Health Measures with Respect to Prostate Cancer.

Proposal: Extend the current authorization for an additional five years.

Rationale: Prostate cancer is most common among men aged 65 years and older. Men in this age group account for about 80 percent of clinically diagnosed prostate cancers. From 1973 to 1992 the incidence of prostate cancer in the United States increased from 64 to 187 per 100,000 persons and the death rates rose by nearly 23%. Increased screening and detection have likely contributed to the recent rise in the incidence of prostate cancer. The American Cancer Society (ACS) estimates that more than 179,300 new cases of prostate cancer will be diagnosed in 1999. Further, it is estimated that 37, 000 men will die of this disease in 1999. Prostate cancer mortality rates are more than 2 times higher among African-American men than white men.

Preventable risk factors for prostate cancer are unknown, and effective measures to prevent the occurrence of this disease do not currently exist. Although one proposed method to reduce the risk of death from prostate cancer is through screening and early detection, health professionals have not come to a consensus on early detection guidelines. Scientific evidence has been insufficient to determine if screening for prostate cancer reduces mortality or if treatment of early disease is more effective than no treatment in prolonging a patient’s life. Currently health practitioners cannot accurately determine which cancers will progress to become clinically significant and which will not. Thus, widespread screening and testing for early detection of prostate cancer is not scientifically justified at this time.

CDC’s efforts regarding prostate cancer focus on assessing the knowledge, attitudes, and practices of men and their physicians regarding prostate cancer screening and treatment that is crucial to designing early detection programs. In addition, funding directed to CDC through the President’s Initiative to Eliminate Racial and Ethnic Disparities in Health currently supports projects in surveillance, prevention research, and education to answer important questions about the epidemiology of prostate cancer and the effectiveness of prostate cancer testing and to develop and disseminate appropriate messages to enable the public, physicians, health departments, policy makers and others to make informed decisions regarding prostate cancer screening and follow-up. These activities are designed to begin to build the science-base on prostate cancer and establish scientifically sound methods of prevention, detection and treatment.

Authorization Level: For FY 2001, $9.2* million; for FY 2002-2005, such sums as necessary.

* CDC has not received appropriations to implement the provisions of this legislative authority. Consequently, amounts budgeted for prostate cancer for FY 2001 do not contain funding for this authority.

CDC-2000/04B

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Confidentiality Law Enforcement Mechanism

Add Enforcement Mechanism to Strengthen Current National Center for Health Statistics’ Confidentiality Law

Current Law: Section 308(d) of the Public Health Service Act states that identifiable information obtained by NCHS may be used only for the purposes for which it was supplied unless otherwise agreed to by the person or establishment providing the information and that the information may not be released in other form if it is identifiable unless the person or establishment providing the information has agreed to the release. However, Section 308(d) does not include any provision for penalties for offenders of this provision.

Proposal: Add an explicit penalty clause to Section 308(d) of the Public Health Service Act, to make breach of confidentiality an enforceable offense under the statute, similar to those applicable penalties under the Health Care Quality and Improvement Act of section 427(b)(2).

Rationale: Providing an enforcement mechanism for the existing confidentiality clause will further protect the privacy and confidentiality of information exchanged between NCHS and its partners. While Section 308(d) includes strong requirements for maintaining the confidentiality of data obtained by NCHS, it does not include penalties to enforce them. The public, including survey respondents, has become increasingly concerned about protecting the privacy of sensitive medical information. Adding penalty provisions to Section 308(d) would demonstrate NCHS’ continuing commitment to protecting personal information and further reassure respondents of the high priority placed on maintaining confidentiality.

Cost: None

CDC-2000/05
1/18/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Sexually Transmitted Disease Programs

Extend authorization of appropriations for grants for research, training and public health programs for the prevention of sexually transmitted diseases.

Current Law: Grants for sexually transmitted disease programs are authorized under section 318 of the Public Health Service Act.

Proposal: Reauthorize appropriations to carry out this program for five additional years.

Rationale: CDC’s STD Prevention Program provides national and international leadership through research, policy development, and support of effective services to prevent and control the transmission of STDs and their complications, such as enhanced HIV transmission, infertility, adverse outcomes of pregnancy, and reproductive tract cancer. CDC provides resources and other program support to all 50 states, 6 cities, the District of Columbia, Puerto Rico, Virgin Islands, and 6 Pacific Island Nations or Territories.

STDs remain among the most critical public health challenges facing the United States today, not only because they are the most frequently reported communicable diseases in the country, but because they cause largely preventable, severe, and costly complications in America’s most vulnerable populations. STDs cause severe consequences for women and infants (especially ethnic and racial minority populations). Their high rates in adolescents and young adults create a heavy disease burden in this group – and STDs facilitate the sexual transmission of human immunodeficiency virus (HIV). The challenge in solving this immense problem centers on overcoming barriers to healthy sexual behaviors in society at large while also delivering comprehensive, effective, essential STD services in innovative ways to high risk individuals at the community level.

Authorization level: For FY 2001, $118.4 million*; for FY 2002-2005, such sums as necessary.

*Excludes $18.2 million for STD-related infertility prevention authorized under PHS Act Section 318A.

CDC-2000/08
1/14/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

Injury Research and Control Program

Reauthorize the Injury Research and Control Program.

Current Law: Section 394(A) of the Public Health Service Act, as redesignated by Section 201(I) of Public Law 103-183, provides authorizations for Section 391, 392, 393, and 394 of that Act through Fiscal Year 1998.

Proposal: Extend the current authorization for an additional five years.

Rationale: Each year over 150,000 Americans die from injuries, and one in three persons suffers a nonfatal injury. Injury is the leading cause of death for Americans, ages 1-44, impacting disproportionately on children, youth, and young adults. It accounts for the deaths of 60 of America’s children every day, which translates to almost three children every hour. Injury now joins the ranks of heart attacks, strokes, and cancer as a major cause of death among seniors. Falls represent the principal cause of death for seniors over age 75. Each year over 5,000 women are murdered in the U.S., and violence kills more youth than any other cause, except for motor vehicle crashes; for African American youth, violence-related injury is the leading cause of death.

Injuries are one of our most expensive health problems, with a lifetime cost estimated at $224 billion. Many of those costs are incurred by the more than 80,000 people in the U.S. who are unnecessarily, but permanently, disabled from brain or spinal cord injury.

CDC’s Injury Research and Control Program is designed to create the system through which we can identify problem areas and emerging issues and monitor progress (surveillance); conduct the research necessary for finding effective solutions; and deliver injury prevention and control interventions and information to people at risk and to the public and private partners who can help lower injury rates.

Authorization Level: For FY 2001, $86.2 million; for FY 2002-2005, such sums as necessary.

CDC-2000/09
1/18/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2001 DHHS LEGISLATIVE PROPOSAL

TBI Research and Reporting

Reauthorize monitoring of incidence and prevalence of traumatic brain injury for an additional five years.

Current Law: Section 4 (a) and (d) of P.L. 104-166 provides appropriations for the Secretary of DHHS, acting through the Public Health Service, to conduct among other things, a study to determine the incidence and prevalence of traumatic brain injury (TBI) and to develop a uniform reproting system under which states report incidents of TBI..

Proposal: Extend authorization for activities to determine incidence and prevalence of traumatic brain injury and to develop a uniform reporting system under which States report incidents of traumatic brain injury.

Rationale: CDC has collected and evaluated state data showing the incidence of TBI, using the 15-state uniform reporting system developed with the funds provided, and prepared a report of its findings for submission to the Congress, as required by Section 4(a). Now that the system has been developed, there is an ongoing need to continue the collection of accurate surveillance data in order to monitor the magnitude and severity of TBI in states and how these factors change over time; to identify risk factors; and to determine which interventions are effective in preventing or reducing the incidence or severity of TBI and TBI-related disabilities.

The proposed reauthorization would support continued monitoring of the incidence and prevalence of TBI. It would also support the continued development and support of a State-based reporting system for TBI. The need for such activities did not end with the completion of the study initially authorized by P.L. 104-166. Surveillance is a necessary element in the development of interventions to prevent or reduce the impact of TBI and TBI-related disabilities. Through the study, CDC set up the mechanism by which surveillance activities can become an integral and ongoing component of the activities envisioned in Section 1 of Public Law 104-166. CDC will continue to publish data from this surveillance system on a periodic basis.

There would be no effect on the roles, rights, or responsibilities of states; nor would any kind of unfunded mandate be imposed upon states. CDC provides expertise, leadership, and coordination to assist state and local governments in implementing effective community injury prevention programs and to assist them in using scarce funds most efficiently. In this effort, we work in partnership with the public and private sectors.

Authorization level: For FY 2001, $3 million; for FY 2002-2--5, such sums as necessary.

CDC-2001/03
1/18/00

CENTERS FOR DISEASE CONTROL AND PREVENTION
FISCAL YEAR 2000 DHHS LEGISLATIVE PROPOSAL

Preventing Sexual Assault Against Women

Reauthorize appropriations for grants to states to carry out rape prevention and education efforts.

Current Law: Section 40151 of Public Law 103-322 (42 U.S.C. 300w-10) authorizes grants to states for rape prevention education programs (the Assistance to Victims of Sexual Assault program). This section is included as footnote to Section 1910A(a)(c) of the Public Health Service Act due to a reference error in P.L.103-322.

Proposal: Reauthorize expiring authorizations of appropriations to carry out this program.

Rationale: The Violent Crime Control and Law Enforcement Act of 1994 (P.L 103-322), which originally authorized this program, provided for appropriations in the amount of $35 million for fiscal years 1996 and 1997 and $45 million for fiscal years 1998-2000. Funding is granted to States to conduct rape prevention education.

These grants have increased the ability of states to prevent and respond to sexual assault in a number of ways. They have provided State health departments the opportunity to add needed staff to oversee the development and implementation of statewide sexual assault prevention activities. They have enabled greater collaboration between sexual assault coalitions and health departments by bringing together expertise from each. For example, several state sexual assault coalitions and health departments are developing and implementing innovative methodology to evaluate their sexual assault prevention activities.

This funding has also provided for development and expansion of hotlines. It has provided for opportunities to collect data that will increase knowledge in these areas and enhance prevention programs and services. Further, states have used the rape prevention and education funds to reach more students and to improve the quality of educational materials. For the first time, many sexual assault coalitions have been able to mount statewide public awareness campaigns to educate the public about sexual assault and services available to victims of sexual assault. Without this funding, these accomplishments will be difficult, if not impossible, to maintain.

Authorization level: For FY 2001, $45 million; for FY 2002-5, such sums as necessary.

Personnel Requirements: Currently 7 FTEs; no growth expected.

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