IMPLEMENTATION OF SCREENING AND BRIEF INTERVENTIONS FOR ALCOHOL-RELATED PROBLEMS

RELEASE DATE:  September 17, 2002

PA NUMBER: PA-02-168

EXPIRATION DATE: This PA expires on August 15, 2005, unless reissued.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
 (http://www.niaaa.nih.gov)
National Institute on Drug Abuse (NIDA)
 (http://www.nida.nih.gov)

THIS PA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this PA
o Research Objectives
o Mechanism(s) of Support 
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Submitting an Application
o Peer Review Process
o Review Criteria
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS PA

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seeks research 
grant applications on the delivery of screening, identification, and brief 
intervention services for alcohol-related problems in medical and other similar 
service settings.  This program announcement (PA) invites research applications 
to test strategies for improving the availability, use of, delivery, quality, 
effectiveness, cost-effectiveness, and outcomes of protocols to screen for and 
identify patients with current or potential alcohol use problems and to 
implement brief interventions to address such problems.   This PA also invites 
research applications to test strategies that facilitate the referral to more 
intensive treatment for those patients for whom specialty care may be indicated.

RESEARCH OBJECTIVES

Background

A large number of people who do not meet the diagnostic criteria for alcohol 
dependence still consume more alcohol than is safe for them -- putting them at 
great risk for health problems, family and work difficulties, motor vehicle 
crashes, and injuries.  In fact, more than 70 percent of drinkers aged 21 or 
older exceed the guidelines for low-risk drinking.  This presents serious 
implications for public health as well as for treating alcohol use problems.  
Despite the fact that many people who drink at levels that put them at risk for 
serious problems do not contact alcohol treatment specialists, they do in fact 
visit a primary care medical practitioner or come into contact with other 
medical caregivers.  

Over the past several decades, interventions were developed in Europe to 
identify persons drinking at levels that either were causing problems or had the 
potential to cause problems and to briefly provide advice or counseling to 
reduce the level of consumption.  Many controlled trials tested these techniques 
in both medical and community settings, and most studies found them efficacious.  
In recent years, efforts to test time-limited strategies such as brief 
interventions have been expanded in North America in attempts to reduce the 
levels of alcohol use among these so-called "risky" drinkers.  Medical and other 
professional personnel have implemented these brief interventions in a variety 
of settings, including primary care medical practices, hospital emergency rooms 
(ER) and trauma centers, and college campuses.  Research has begun to 
demonstrate the efficacy and effectiveness of brief interventions across those 
and other settings and in populations -- adolescents, older adults, and pregnant 
women -- that typically have not received much attention from the traditional 
system of specialized alcohol dependence treatment.

Brief intervention is a time-limited, patient-centered counseling strategy 
focused on changing behaviors.  Typically, a brief intervention consists of four 
or fewer sessions lasting from a few minutes to an hour.  It is most frequently 
used to reduce the alcohol consumption of patients who are not alcohol-dependent 
but may be followed by referral to more intensive treatment for persons who do 
not respond to brief counseling alone or for persons who are alcohol-dependent.

Primary Care Practice Settings:

Several early studies in the United Kingdom investigated brief counseling 
interventions in general medical practices.  Wallace and colleagues (Wallace et 
al.1988) found reduced drinking levels after one year in patients that received 
two interventions of 5 to 10 minutes each followed by two 5-minute telephone 
calls.  In addition, men in the intervention group had reduced blood pressure 
and healthier liver enzyme levels.  Anderson and Scott (1992) demonstrated that 
male patients receiving 10 minutes of physician advice plus feedback from 
assessment measures and a self-help information booklet reduced alcohol 
consumption at 1-year follow-up.  Female patients from both the intervention and 
control groups showed significant reductions in consumption (Scott and Anderson 
1991).  The authors suggest that the lack of difference between groups may be 
attributable to contamination of the control group by informal alcohol 
interventions.  In one of the early North American studies, Israel and 
colleagues (1996) demonstrated that cognitive-behavior counseling was 
significantly more effective than simple advice at reducing alcohol consumption, 
psychosocial problems, liver enzyme levels that reflect alcohol use, and 
frequency of subsequent physician visits.  Fleming and colleagues (1997) 
observed that men and women receiving two counseling visits of 10 to 15 minutes 
and two 5-minute follow-up phone calls showed significant reductions in alcohol 
use during the preceding week, in episodes of binge drinking, and in frequency 
of excessive drinking. Sustained reductions in alcohol use have been observed at 
48-month follow-up.  Another study found that primary care physicians and nurse 
practitioners who received brief training in skills, attitudes, and knowledge 
regarding high-risk drinking were able to significantly increase their 
counseling skills, their preparedness to intervene with at-risk drinkers, and 
the perceived usefulness of intervention (Ockene et al, 1997, 1999; Adams et al, 
1998).  At six-month follow-up, alcohol consumption was significantly reduced 
for patients who had received brief interventions during the course of their 
routine primary medical care.

Emergency Care Settings: 

Gentilello and colleagues (1999) showed that patients admitted for injuries to a 
Level 1 trauma center that received a single motivational interview (MI) with a 
psychologist decreased alcohol consumption significantly at 12 months with the 
reduction most apparent in patients with mild to moderate alcohol problems. In 
addition, there was a 47 percent reduction in injuries requiring either 
emergency department or trauma center admission at one-year follow-up and a 48 
percent reduction in injuries requiring hospital admission at three-year follow-
up.  Another study evaluated the use of a 30-minute MI in the ER to reduce 
alcohol-related consequences and use among adolescents following an alcohol-
related event (Monti et al., 1999). Follow-up assessments at six months showed 
that patients who received the MI had a significantly lower incidence of 
drinking and driving, traffic violations, alcohol-related injuries, and alcohol-
related problems than patients who received standard care.  Both groups showed 
reduced alcohol consumption, but the harm-reduction focus of the MI intervention 
produced additional benefits by further reducing negative outcomes related to 
drinking.  Similarly, Longabaugh and colleagues (2001) found that patients 
treated for injuries in a hospital emergency department (ED) receiving both a 
40-60 minute MI intervention and a booster MI session 7 to 10 days later 
reported fewer negative consequences form drinking and fewer alcohol-related 
injuries at 1-year follow-up, as compared to patients receiving no MI treatment 
and those receiving the MI treatment with the booster session.  Patients in all 
three groups reduced their days of heavy drinking (6 or more drinks on one 
occasion).

Interventions with Other Populations: 

Fleming and colleagues (1999) tested the effects of brief advice from primary 
care physicians in reducing alcohol use by older adult problem drinkers.  
Patients receiving the brief intervention demonstrated significant reductions in 
alcohol use from the previous week, episodes of binge drinking, and frequency of 
excessive drinking. In a project designed to reduce prenatal alcohol consumption 
among pregnant women, Chang and colleagues (1999, 2000) provided patients with a 
two-hour assessment only or a two-hour assessment plus a brief intervention by a 
physician.  More than half of the subjects screened had stopped drinking alcohol 
by the time of random assignment, presumably because of their pregnancy.  Among 
the women who were abstinent prior to the comprehensive assessment, those who 
received the brief intervention maintained higher rates of abstinence throughout 
the pregnancy. However, women in both groups significantly reduced their alcohol 
use.  The minimal differences between the groups may very well be attributable 
to the intensity of the assessment serving as a brief intervention in itself, so 
that additional contributions from the supplementary intervention were 
negligible.  Finally, the effectiveness of brief interventions for reducing 
alcohol use and alcohol-related problems among college students has been 
demonstrated (Marlatt, 1995, 1998).  Heavy-drinking students who received a one-
hour counseling session with personalized feedback and a discussion of drinking 
risks and norms showed a decrease in alcohol-related problems and in alcohol use 
and binge drinking over two years.  High-risk drinking freshmen who received 
individual motivational interviews and personalized feedback reports on drinking 
patterns and risks had greater reductions in alcohol use and alcohol-related 
problems than did high-risk drinkers in a comparison group.  

Cost Analyses of Brief Interventions: 

Critical examinations of the true costs and actual benefits of a particular 
intervention are essential, especially in the current era of resource 
conservation.  One recent study estimated the economic benefits of a brief 
intervention in the primary medical care setting (Fleming et al, 2000). The 
average per-subject benefit of the intervention was $1,151, while the cost per 
subject was $205, yielding a benefit-cost ration of 5.6:1.  Specifically, this 
analysis suggests that an investment of $10,000 in treatment resulted in a total 
benefit of $56,263.  It also offers evidence that brief interventions for 
problem drinkers can generate positive net benefit for patients, the health care 
system, and society.

Specific Areas of Interest

Brief interventions with non-dependent but high-risk drinkers have been shown to 
have positive effects in reducing alcohol use and alcohol-related problems 
across a broad range of settings and with a broad range of patient 
subpopulations.  Still, a great deal remains to be done in order to consolidate 
and expand our understanding of this intervention strategy. Consequently NIAAA 
encourages continued investigation into the implementation and application of 
brief intervention models in a variety of applied and real-world settings.

Examples of potential research questions include but are not limited to:

- How can the effects of brief interventions be maintained and even strengthened 
over time?  Will booster sessions or re-interventions at specified intervals 
achieve this?  
- What are the active ingredients of these types of interventions?  Do they 
differ across various settings or patient populations?
- How can the brief window of intervention opportunity be used most efficiently? 
- How can screening and brief interventions for alcohol use problems be more 
fully integrated into the routine practices and procedures of our existing 
health care system?  What are the individual, institutional, financial, and 
societal barriers to such integration?
- Do brief interventions reduce overall health care costs?  Do they reduce other 
societal costs?
- How can screening tools be streamlined to improve both their efficiency and 
their likelihood of use in medical settings yet still achieve an optimum level 
of sensitivity and specificity?
- What technological or managerial innovations can facilitate the implementation 
and adoption of screening and brief intervention protocols.
- How do patient characteristics, especially cultural or ethnic variations, 
influence the effectiveness of brief interventions for alcohol problems?
- How do possible co-occurring disorders (physiological or psychiatric) 
influence the effectiveness of brief interventions for alcohol problems? 
- How can referral to more intensive treatments be improved to facilitate 
patient adherence and increase cost efficiencies?
- How can screening and brief intervention protocols originally implemented in 
medical care settings be adopted by other social agency systems (e.g., 
family/child welfare, corrections, etc.)?

MECHANISM (S) OF SUPPORT 

This PA will use the NIH research project grant (R01) small grant (R03) and 
exploratory/developmental grant (R21) award mechanism. As an applicant, you will 
be solely responsible for planning, directing, and executing the proposed 
project. The total project period for a research project grant (R01) application 
submitted in response to this Program Announcement may not exceed 5 years. 

Under the NIAAA Small Grant mechanism (R03) applicants may request either 
$25,000 or $50,000 in direct costs per year for up to two years. These awards 
are not renewable; however, a no-cost extension of up to one year may be granted 
to the grantee institution prior to expiration of the project period. Before 
completion of the R03, investigators are encouraged to seek continuing support 
for research through a research project grant (R01). (See Program Announcement 
PA- 99-098, "NIAAA Small Grant Program," 
http://grants.nih.gov/grants/guide/pa-files/PAR-99-098.html, for a complete 
description of the R03 mechanism.) 

NIAAA exploratory/developmental grants (R21) are limited to 3 years for up to 
$100,000/year for direct costs. (See Program Announcement PA- 99-131, "NIAAA 
Exploratory/Developmental Grant Program," 
http://grants.nih.gov/grants/guide/pa-files/PA-99-131.html, for a complete 
description of the R21 mechanism.) 

The NIDA exploratory/developmental (R21) grants are limited to 3 years and NIDA 
small grants (R03) are limited to 2 years.  Both are non-renewable and limited 
in direct cost amount per year (R03, $50,000; R21, $100,000).

The NIDA R03 mechanism 
(http://grants.nih.gov/grants/guide/pa-files/PAR-00-059.html) is intended for 
newer, less experienced investigators, for investigators at institutions without 
well-developed research traditions and resources, or for experienced 
investigators wishing to change research directions or test new methods or 
techniques. 

The NIDA R21 mechanism 
(http://grants.nih.gov/grants/guide/pa-files/PA-01-012.html) is intended to 
encourage exploratory research projects with sound methodology and strong 
rationales in underdeveloped research areas of drug abuse.

This PA uses just-in-time concepts. It also uses the modular as well as the non-
modular budgeting formats (see 
http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if you 
are submitting an application with direct costs in each year of $250,000 or 
less, use the modular format. Otherwise follow the instructions for non-modular 
research grant applications. 

ELIGIBLE INSTITUTIONS 

You may submit (an) application(s) if your institution has any of the following 
characteristics: 

- For-profit or non-profit organizations 
- Public or private institutions, such as universities, colleges, hospitals, and 
laboratories 
- Units of State and local governments
- Eligible agencies of the Federal government 
- Domestic or foreign
- Faith-based or community based organizations 

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS 

Any individual with the skills, knowledge, and resources necessary to carry out 
the proposed research is invited to work with their institution to develop an 
application for support. Individuals from underrepresented racial and ethnic 
groups as well as individuals with disabilities are always encouraged to apply 
for NIH programs. 

WHERE TO SEND INQUIRIES 

We encourage your inquiries concerning this PA and welcome the opportunity 
answer questions from potential applicants. Inquiries may fall into two areas: 
scientific/research and financial or grants management issues: 

Direct your questions about scientific/research issues to: 

Harold I. Perl, Ph.D. 
Division of Clinical and Prevention Research 
National Institute on Alcohol Abuse and Alcoholism 
6000 Executive Boulevard, Suite 505 MSC 7003 
Bethesda, MD 20892-7003 
For express mail use: Rockville, MD 20852) 
Telephone: (301) 443-0786
Fax: (301) 443-8774 
Email: perl@nih.gov

National Institute on Drug Abuse

Cecelia McNamara, Ph.D.
Behavioral Treatment Development Branch
Division of Treatment Research
6001 Executive Blvd
Room 4240 MSC 9551
Bethesda, MD 20892-9551Telephone:  (301) 443-0107
Email:  cmcnamar@mail.nih.gov

Direct your questions about financial or grants management matters to:

Judy Simons
Chief, Grants Management Branch
Office of Planning and Resource Management
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 504
6000 Executive Boulevard, MSC 7003
Bethesda, MD 20892-7003
(301) 443-4704 (telephone)
(301) 443-3891 (fax)
email:  jsimons@willco.niaaa.nih.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 435-0714, 
Email: GrantsInfo@nih.gov.

APPLICATION RECEIPT DATES: Applications submitted in response to this program 
announcement will be accepted at the standard application deadlines, which are 
available at http://grants.nih.gov/grants/dates.htm.  Application deadlines are 
also indicated in the PHS 398 application kit.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting up 
to $250,000 per year in direct costs must be submitted in a modular grant 
format.  The modular grant format simplifies the preparation of the budget in 
these applications by limiting the level of budgetary detail.  Applicants 
request direct costs in $25,000 modules.  Section C of the research grant 
application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular grants 
is available at http://grants.nih.gov/grants/funding/modular/modular.htm.

SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: 
Applications requesting $500,000 or more in direct costs for any year must 
include a cover letter identifying the NIAAA staff member who has agreed to 
accept assignment of the application.   

Applicants requesting more than $500,000 must carry out the following steps:
	
1) Contact the IC program staff at least 6 weeks before submitting the 
application, i.e., as you are developing plans for the study; 

2) Obtain agreement from the IC staff that the IC will accept your application 
for consideration for award; and,
  
3) Identify, in a cover letter sent with the application, the staff member and 
IC who agreed to accept assignment of the application.  

This policy applies to all investigator-initiated new (type 1), competing 
continuation (type 2), competing supplement, or any amended or revised version 
of these grant application types. Additional information on this policy is 
available in the NIH Guide for Grants and Contracts, October 19, 2001 at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. 

SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the 
application, including the checklist, and five signed photocopies in one package 
to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)

APPLICATION PROCESSING: Applications must be received by or mailed on or before 
the receipt dates described at 
http://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR will not 
accept any application in response to this PA that is essentially the same as 
one currently pending initial review unless the applicant withdraws the pending 
application.  The CSR will not accept any application that is essentially the 
same as one already reviewed.  This does not preclude the submission of a 
substantial revision of an application already reviewed, but such application 
must include an Introduction addressing the previous critique.

PEER REVIEW PROCESS

Applications submitted for this PA will be assigned on the basis of established 
PHS referral guidelines.  An appropriate scientific review group convened in 
accordance with the standard NIH peer review procedures 
(http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific 
and technical merit.  

As part of the initial merit review, all applications will:

o Receive a written critique
o Undergo a selection process in which only those applications deemed to have 
the highest scientific merit, generally the top half of applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the appropriate national advisory council or 
board
	
REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In the 
written comments, reviewers will be asked to discuss the following aspects of 
your application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these criteria in 
assigning your application's overall score, weighting them as appropriate for 
each application.  Your application does not need to be strong in all categories 
to be judged likely to have major scientific impact and thus deserve a high 
priority score.  For example, you may propose to carry out important work that 
by its nature is not innovative but is essential to move a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem? If the aims of 
your application are achieved, how do they advance scientific knowledge?  What 
will be the effect of these studies on the concepts or methods that drive this 
field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or methods? 
Are the aims original and innovative?  Does your project challenge existing 
paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work will be 
done contribute to the probability of success?  Do the proposed experiments take 
advantage of unique features of the scientific environment or employ useful 
collaborative arrangements?  Is there evidence of institutional support?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application 
will also be reviewed with respect to the following:

PROTECTIONS:  The adequacy of the proposed protection for humans, animals, or 
the environment, to the extent they may be adversely affected by the project 
proposed in the application.

INCLUSION:  The adequacy of plans to include subjects from both genders, all 
racial and ethnic groups (and subgroups), and children as appropriate for the 
scientific goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated. (See Inclusion Criteria included in the section 
on Federal Citations, below)

BUDGET:  The reasonableness of the proposed budget and the requested period of 
support in relation to the proposed research.

AWARD CRITERIA

Applications submitted in response to a PA will compete for available funds with 
all other recommended applications.  The following will be considered in making 
funding decisions:  

o Scientific merit of the proposed project as determined by peer review
o Availability of funds 
o Relevance to program priorities

REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components 
involving Phase I and II clinical trials must include provisions for assessment 
of patient eligibility and status, rigorous data management, quality assurance, 
and auditing procedures.  In addition, it is NIH policy that all clinical trials 
require data and safety monitoring, with the method and degree of monitoring 
being commensurate with the risks (NIH Policy for Data Safety and Monitoring, 
NIH Guide for Grants and Contracts, June 12, 1998: 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of the 
NIH that women and members of minority groups and their sub-populations must be 
included in all NIH-supported clinical research projects unless a clear and 
compelling justification is provided indicating that inclusion is inappropriate 
with respect to the health of the subjects or the purpose of the research. This 
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public 
Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete 
copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) all 
applications or proposals and/or protocols must provide a description of plans 
to conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) 
investigators must report annual accrual and progress in conducting analyses, 
as appropriate, by sex/gender and/or racial/ethnic group differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:  
The NIH maintains a policy that children (i.e., individuals under the age of 
21) must be included in all human subjects research, conducted or supported by 
the NIH, unless there are scientific and ethical reasons not to include them. 
This policy applies to all initial (Type 1) applications submitted for receipt 
dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS:  NIH policy 
requires education on the protection of human subject participants for all 
investigators submitting NIH proposals for research involving human subjects.  
You will find this policy announcement in the NIH Guide for Grants and 
Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a project 
that is supported in whole or in part with Federal funds and (2) cited publicly 
and officially by a Federal agency in support of an action that has the force 
and effect of law (i.e., a regulation) may be accessed through FOIA.  It is 
important for applicants to understand the basic scope of this amendment.  NIH 
has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public archive, 
which can provide protections for the data and manage the distribution for an 
indefinite period of time.  If so, the application should include a description 
of the archiving plan in the study design and include information about this in 
the budget justification section of the application. In addition, applicants 
should think about how to structure informed consent statements and other human 
subjects procedures given the potential for wider use of data collected under 
this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in a NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.   Furthermore, we 
caution reviewers that their anonymity may be compromised when they directly 
access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving 
the health promotion and disease prevention objectives of "Healthy People 
2010," a PHS-led national activity for setting priority areas. This PA is 
related to one or more of the priority areas. Potential applicants may obtain a 
copy of "Healthy People 2010" at http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal 
Domestic Assistance No. 93.273, and is not subject to the intergovernmental 
review requirements of Executive Order 12372 or Health Systems Agency review.  
Awards are made under authorization of Sections 301 and 405 of the Public Health 
Service Act as amended (42 USC 241 and 284) and administered under NIH grants 
policies described at http://grants.nih.gov/grants/policy/policy.htm  and under 
Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. 

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, Public 
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain 
facilities (or in some cases, any portion of a facility) in which regular or 
routine education, library, day care, health care, or early childhood 
development services are provided to children.  This is consistent with the PHS 
mission to protect and advance the physical and mental health of the American 
people. http://grants.nih.gov/grants/guide/pa-files/PA-02-015.html. 

REFERENCES

Adams A, Ockene JK, Wheeler EV Hurley TG, Alcohol counseling: physicians will do 
it.  J Gen Intern Med 1998 Oct; 13(10): 692-8.

Anderson, P, Scott, E, Effect of general practitioners' advice to heavy drinking 
men. British Journal of Addiction, 1992, 87(6): 891-900.

Chang G, Goetz MA, Wilkins-Haug L, Berman S, Brief intervention for prenatal 
alcohol use: an in-depth look.  J Subst Abuse Treat 2000 Jun; 18(4): 365-9.

Chang G, Wilkins-Haug L, Berman S, Goetz MA, Brief intervention for alcohol use 
in pregnancy: a randomized trial.  Addiction 1999 Oct; 94(10): 1499-508.

Fleming MF, Barry KL, Manwell LB, Johnson K, London R, Brief physician advice 
for problem alcohol drinkers.  A randomized controlled trial in community-based 
primary care practices.  JAMA 1997 Apr 2; 227(13): 1039-45.

Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA, Brief physician 
advice for alcohol problems in older adults: a randomized community-based trial.  
J Fam Pract 1999 May; 48(5): 378-84.

Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL, Benefit-
cost analysis of brief physician advice with problem drinkers in primary care 
settings. Med Care 2000 Jan; 38(1): 7-18.

Gentilello LM, Rivara FP, Donovan DM Jurkovich GJ, Daranciang E., Dunn CW, 
Villaveces A, Copass M, Ries RR, Alcohol interventions in a trauma center as a 
means of reducing the risk of injury recurrence.  Ann Surg 1999 Oct; 230(4): 
473-80; discussion 480-3.

Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, Gengrich R, Rankin 
JG, Screening for problem drinking and counseling by the primary care physician-
nurse team. Alcohol Clin Exp Res 1996 Nov; 20(8): 1443-50.

Marlatt, GA, Baer JS, Kivlahan DR, Dimeff LA, Larimer ME, Quigley LA, Somers JM, 
Williams E, Screening and brief intervention for high-risk college student 
drinkers: Results from a 2-year follow-up assessment. J Consult Clin Psychol 
1998, 66(4): 604-615.

Marlatt, GA, Baer JS, Larimer M, Preventing alcohol abuse in college students: A 
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