October 29, 2024
National Cancer Institute (NCI)
Whole of Systems Approaches (WSA) - A WSA draws on complexity science and complex adaptive systems which explain the ways in which factors and relationships interact and create sets of outcomes. WSA have been defined to include features such as: 1) Identification of a system and its boundaries; 2) Capacity building; 3) Creativity and innovation; 4) Establishing relationships; 5) Engagement; 6) Establishing strong methods for communication across the system; 7) Embedding action and policies within organizations; 8) Developing leadership throughout the system; 9) Robustness and sustainability; and 10) Monitoring and evaluation.
Policy, Systems, and Environment Approaches (PSE) - PSE approaches work at a macro level and aim to improve health by changing factors such as rules or laws (policy); organizational procedures or protocols (systems); or physical, social, and economic environments.
There is consistent evidence that obesity, often defined based on elevated body mass index (BMI), is associated with increased risk of 13 cancers. In 2020 ~42% of US adults aged 18 years and older had BMIs above 30, and an analysis of data from 2019 indicated that excess body weight was responsible for 4% to 6% of incident cancer cases among men and from 7% to 11% among women. Obesity also exhibits significant disparities, with higher rates of obesity in Non-Hispanic Black Americans (50%) and Hispanic Americans (45.6%). Behavioral interventions for obesity can contribute to weight loss, but these have not been implemented at the population level and weight regain is common upon intervention completion. More recently, the approval of glucagon-like peptide 1 (GLP-1) agonists for treatment of obesity suggests that pharmacotherapies could have a significant effect on the prevalence of obesity. However, recent data indicate that more than half of people stop taking such drugs within a year for several reasons, including cost, experiences of a weight loss plateau, side effects, and shortages in supply. Moreover, the expected off-label costs of GLP-1 and other drugs suggest that other approaches remain necessary.
Additionally, weight loss alone is not a complete solution to population health and cancer prevention related to energy balance, diet and alcohol intake, and physical activity. For example, unhealthy dietary patterns, unhealthy alcohol consumption, lack of physical activity, and reduced weight but low fitness, are associated with obesity and contribute to cancer risk. Focusing on individual pharmacological or behavioral interventions alone will not fulfill the goals of cancer prevention.
Substantial public health evidence on how to address diverse public health challenges suggests that multilevel and multisectoral approaches can maximize the success of efforts to address key modifiable risk factors. The classic example of this approach is in tobacco control where it is well established that a combination of environmental and policy approaches (e.g., regulating sales, smoke free laws, increased taxes, and changing social norms about tobacco use), pharmacotherapy, and effective behavioral interventions (e.g., promotion of cessation counseling and web-based resources such as smokefree.gov), have resulted in a reduced prevalence of tobacco use in the US from >50% in men (1955) and >30% in women (1965) to 13% of men and 10% of women who smoked cigarettes in 2021. This reduction in smoking has in turn been a major factor in the large decreases in cancers, especially lung cancer, that have occurred in recent years.
Based on the arguments briefly mentioned above, a whole of systems approach to obesity prevention and control would include the best possible access to individual level behavioral and pharmacological approaches to obesity, and a set of PSE approaches to obesity targeted to the particular needs of communities at the municipal, county, or state level. Examples of PSE approaches to obesity prevention include the introduction of sugar sweetened beverage taxes, point of sale nutrition labelling, investment in the built and natural environment to reduce sedentary time, promotion of active transportation, modification of school system policies to improve food quality, changes in policies and programs to address nutrition security and housing security, support for efforts to improve healthy food access in underserved areas, and many others. Exactly which combination of PSE approaches to select depends on geographic and political circumstances, community engagement, and other factors. These approaches will require engaging the community, local government, non-profits, and elements of the commercial sector along with the cancer and health care delivery communities.
One critical issue involves the possibility of unintended consequences and differential effects on communities and demographic groups. For example, improvements to the built, green, and transportation environments can result in gentrification and displacement. Thus, it is critically important for teams attempting to address obesity at the whole of system level to consider equity and the history of PSE efforts in their communities of interest.
The short-term goal of the supplemental funding is to support foundational efforts that will help set the stage for greater efforts to address obesity, one of the major modifiable risk factors for cancer, as well as additional obesity risk factors that contribute to cancer such as unhealthy dietary patterns, unhealthy alcohol consumption, and lack of physical activity.
The research objectives of this supplement notice are to: 1) Examine the prevalence of obesity in cancer center catchment areas or relevant administrative units such as cities, counties, or states, 2) Carry out an environmental scan of key collaborators and the policy landscape in these areas that are related to or addressing obesity and its determinants, and 3) Convene representatives of these groups to discuss and report out on the community and organizational readiness to develop and evaluate a whole of systems approach to obesity including both enhanced obesity care, prevention, and PSE approaches to both these aspects of obesity.
Investigators should request supplement support to do the following:
Applications involving collaborations between NCI grant recipients eligible for supplements and relevant local partners such as leading researchers from a university, a state or local health department, or a key community organization are encouraged. However, such partners could also be engaged after the award.
Applications not responsive to this NOSI include those that:
Applications are not required to address all 10 WSA elements but should provide a rational if any elements are not addressed. All applicants are encouraged to discuss their applications with the scientific/research contact listed in this NOSI (below) prior to submission.
Applications for this initiative must be submitted using the following opportunity or its subsequent reissued equivalent.
All instructions in the SF424 (R&R) Application Guide and PA-20-272 must be followed, with the following additions:
Budget.
Submitting Applications.
Application Due Date: Submissions must be received by January 31, 2025, at 5:00 PM local time of applicant organization for FY 2025 funding. The NOSI will expire February 2, 2025.
Page Limits:
The application must include the following sections and adhere to the following limits:
NCI will conduct administrative reviews of applications and will support the most meritorious applications submitted for consideration, based upon availability of funds. Additionally, NCI program staff will evaluate applications using the following selection factors:
Applicants are encouraged to discuss their application with the scientific/research contacts listed in this NOSI prior to submission.
Scientific Contacts
David Berrigan, PhD, MPH
National Cancer Institute (NCI)
Telephone: 240-276-6752
Email: berrigad@mail.nih.gov
Jill Reedy, PhD, MPH, RDN
National Cancer Institute (NCI)
Telephone: 240-276-6812
Email: reedyj@mail.nih.gov
Financial/Grants Management Contact(s)
Crystal Wolfrey
National Cancer Institute (NCI)
Telephone: 240-276-6277
Email: wolfreyc@mail.nih.gov