Full Text PA-95-060

DRUG AND ALCOHOL USE AND ABUSE IN RURAL AMERICA

NIH GUIDE, Volume 24, Number 16, May 12, 1995

PA NUMBER:  PA-95-060

P.T.


Keywords: 


National Institute on Drug Abuse
National Institute on Alcohol Abuse and Alcoholism
Department of Agriculture

PURPOSE

The purpose of this program announcement is to encourage research on
drug and alcohol use and abuse behaviors in rural America, the
consequences of such use/abuse, and the delivery of appropriate
prevention and treatment services.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This program
announcement, Drug and Alcohol Use and Abuse in Rural America, is
primarily related to the priority area of alcohol and other drugs.
Potential applicants may obtain a copy of "Healthy People 2000" (Full
Report:  Stock No. 017-001-00474-0 or Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as principal investigators.
Foreign institutions are not eligible for First Independent Research
Support and Transition (FIRST) (R29) awards.

MECHANISM OF SUPPORT

Research support mechanisms include research project grants (R01),
small grants (R03), and  FIRST (R29) awards.  Submissions as
Investigator- Initiated Interactive Research Project Grants (IRPG)
may also be made.  For more information on the IRPG mechanism, see
NIH Guide, Vol. 23, No. 28, July 29, 1994.  Because the nature and
scope of the research proposed in response to this program
announcement may vary, it is anticipated that the size of an award
will vary also.

Small grants provide research support of up to $50,000 per year in
direct costs plus appropriate indirect costs for up to two years.
FIRST awards provide support for five years and up to $350,000 in
direct costs over the entire project period.  Copies of the program
announcements for R03 and R29 may be obtained from program staff
listed under INQUIRIES.

RESEARCH OBJECTIVES

Background

Little research attention has been given to issues of drug and
alcohol use and abuse in U.S. populations residing in rural areas.
"Rural" can be defined in several ways: by distance from urban areas,
by type of economic base, by density of population, and, in the case
of Native American populations, by the geographic location of
reservations.  Rural has been defined also as a "cultural"
perspective of the world as well as a normative structure.  It is
additionally defined by the distribution of scarce resources and
services.

Recent epidemiologic data, although sparse, show that rates of drug
and alcohol use and abuse in rural areas vary, depending on the
demographics of the area.  They can be quite low or high relative to
rates measured in the inner areas of large cities.  More systematic
measures of these rates and reasons for their variation should be the
focus of further investigation.  The etiology of drug and alcohol
abuse in rural populations also requires study.  Researchers believe
that declining economic opportunities in these groups are undermining
family structures and dynamics, which previously served as protective
factors against substance abuse.  However, this hypothesis needs to
be systematically tested in relevant communities.

The economic impact of the 1980s on rural areas in terms of lost jobs
and migration to more urban areas has depleted available resources
that supported the delivery of health, mental health, and drug and
alcohol abuse prevention and treatment services.  However, the
specific nature of current service delivery systems, how they are
organized, and who they reach are topics that have not been well
documented.  Furthermore, opportunities for innovative delivery
models may present themselves, particularly within community
settings.

Finally, the special needs of certain population groups within the
rural setting have not been well addressed.  Native Americans,
migrant workers, Hispanics, and African Americans have been found to
have differing patterns of drug and alcohol abuse and associated
consequences and to be confronted with varying barriers to accessing
prevention and treatment services. Specific studies that examine
these issues and innovative service delivery models are encouraged.

Program Description

Three areas of research are sought through this program announcement.
These areas include epidemiology/etiology and prevention and
treatment services research.  Examples of research areas to be
addressed are provided below.

Epidemiology/Etiology

o  Epidemiologic descriptions of patterns of drug and alcohol abuse,
of the characteristics of those who evidence these patterns, and of
the social/economic/environmental context associated with prevalence
and incidence patterns.  Especially encouraged is building upon
existing epidemiologic systems such as the NIDA-sponsored Community
Epidemiology Work Group (CEWG).  Additionally, special attention is
encouraged on the impact of both in- and out-migration in rural
areas.

o  Documentation of the health (specifically HIV and AIDS,
tuberculosis, and sexually-transmitted diseases), social-legal, and
economic consequences of drug and alcohol abuse.

o  Identification of the processes associated with initiating drug
and alcohol use and progression to abuse/dependence, including
periods of discontinuation and the factors that are associated with
this progression and/or discontinuation.  Special emphasis should be
given to determining protective factors (processes) that prevent or
interrupt progression with a focus on community-family factors that
promote or protect against such consequences.

o  Specification of varying use and abuse patterns for different
cultural, ethnic, gender, generational, and occupational subgroups
within rural populations (e.g., farmers, fishermen, miners,
lumbermen, blue and white collar manufacturing and service
personnel).

Drug and Alcohol Abuse Intervention for Prevention and Treatment of
Services Research

o  Development and testing of innovative multi-strategy,
comprehensive prevention and/or treatment interventions that are
community-based.

o  Development and testing of single-channel prevention strategies
such as media, worksite, family-based, or school-based approaches.

o  Evaluation of existing prevention/intervention and treatment
services being delivered to rural populations.  Both quantitative and
ethnographic research approaches are encouraged where appropriate,
including studies of special subpopulations such as those living in
economically depressed communities (e.g., Appalachia and mobile
communities such as migrant farm workers).

o  Assessments of the impact of prevention/intervention and/or
treatment strategies or service delivery at the community, state,
regional, or national level, including the effects of specific laws
or regulations such as controls on the availability of alcohol.

o  Assessment of outreach strategies to expand prevention and
treatment intervention and/or services to underserved populations in
rural areas.

o  Research on methods for diffusion of innovative clinical practices
and management techniques to improve prevention/intervention and
treatment services and lower program costs.

o  Research on consumer choice, prevention/treatment program
selection, and service retention resulting from existing or
innovative practices.

o  Research to integrate drug and alcohol abuse prevention approaches
with interventions directed at other related behavioral and societal
problems such as violence, teenage pregnancy, school dropouts,
domestic abuse, HIV and STDs.

o  Prevention intervention research for preschool and elementary
students with possible drug and alcohol induced learning disorders.

o  The operation and impact of financing mechanisms relating to
substance abuse treatment should be studied, particularly in sparsely
populated areas.  Adequacy of coverage in rural states, under private
coverage and medicaid, and how rural providers utilize such
mechanisms is of particular interest.

o  The organization of prevention and treatment services may be
problematic in rural areas, affecting access and utilization as a
function of population density and economic factors.  Patterns of
utilization, organization of services, and how linkages between
primary care and drug abuse services affect utilization, quality of
care, and outcomes.

o  Management of care in health systems in rural areas is of
interest.  How are managed care systems organized, and what are the
consequences in terms of decision processes, adequacy, quality, and
appropriateness of services, continuity and integration of services,
and outcomes.  What case management models are evident and how is
managed care used to link services?

Acknowledgement of funding for research from either or both
Institutes and from the United States Department of Agriculture (when
it has been determined through discussions between the applicant and
one or both Institutes that Agriculture funds have been allocated to
the Institutes and are being used to help fund applicant's grant)
must be given on all published and unpublished reports.  It is also
desirable to credit the two Institutes and Agriculture for relevant
technical assistance provided during the course of the grant.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS

It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990. The new policy contains some new
provisions that are substantially different from the 1990 policies.

All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion of Women and Minorities as
Subjects in Clinical Research", which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513), and reprinted
in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume
23, Number 11.

Investigators may obtain copies from these sources or from the
program staff or contact person listed below.  Program staff may also
provide additional relevant information concerning the policy.

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS
398 (rev. 9/91) and will be accepted at the standard receipt dates
indicated in the application kit.  Application kits are available at
most institutional offices of sponsored research and may be obtained
from the Office of Grants Information, Division of Research Grants,
National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD
20892, telephone 301/435-0714.  The title and number of the program
announcement must be typed in Section 2a on the face page of the
application.

FIRST (R29) award applicants must include at least three sealed
letters of reference attached to the face page of the original
application.  FIRST applications submitted without the required
number of reference letters will be considered incomplete and will be
returned without review.

The completed original application and five legible copies must be
sent or delivered to:

Division of Research Grants
National Institutes of Health
6701 Rockledge Drive, Room 1040 - MSC 7710
Bethesda, MD  20892-7710*
Bethesda, MD  20817 (for overnight/express service)

REVIEW CONSIDERATIONS

Applications that are complete and responsive to the program
announcement will be evaluated for scientific and technical merit by
an appropriate peer review group convened in accordance with the
standard NIH peer review procedures.  As part of the initial merit
review, all applications will receive a written critique and undergo
a process in which only those applications deemed to have the highest
scientific merit, generally the top half of applications under
review, will be discussed, assigned a priority score, and receive a
second level review by the appropriate national advisory council or
board.

Review Criteria

o  Scientific or technical significance and originality of the
proposed research;

o  Appropriateness and adequacy of the research approach and
methodology proposed to carry out the research;

o  Qualifications and research experience of the principal
investigator and staff;

o  Availability of resources necessary to the research;

o  Appropriateness of the proposed budget and duration in relation to
the proposed research; and

o  Adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.

The initial review group will also examine the provisions for the
protection of human and animal subjects, and safety of the research
environment.

AWARD CRITERIA

Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding
decisions:  quality of the proposed project as determined by the peer
review, availability of funds, and program priority.

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct inquiries on the scientific and programmatic aspects to:

Peter Hartsock, Dr. P.H.
Division of Epidemiology and Prevention Research
National Institute on Drug Abuse
5600 Fishers Lane, Room 9A-53
Rockville, MD  20857
Telephone:  (301) 443-6720
FAX:  (301) 443-2636
Email:  ph45z@nih.gov

Gayle Boyd, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 505
Bethesda, MD  20892-7003
Telephone:  (301) 443-8766
FAX:  (301) 443-8774
Email:  gboyd@willco.niaaa.nih.gov

Elizabeth Robertson, Ph.D.
U.S. Department of Agriculture
Agriculture Research Service
Unit No. 83
Riverdale, MD  20737
Telephone:  (301) 734-8596
Email:  erobertson@assrr.ars45da.gov

Direct inquiries regarding fiscal matters related to drug abuse
relevant studies to:

Dr. Gary Fleming
Chief, Grants Management Branch
5600 Fishers Lane, Room 8A-54
Rockville, MD  20857
Telephone:  (301) 443-6710
FAX:  (301) 443-6487
Email:  gfleming@aoada2.ssw.dhhs.gov

Direct inquiries regarding fiscal matters related to alcohol abuse
relevant studies to:

Mr. Joseph Weeda
Chief, Grants Management Branch
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 504
Rockville, MD  20892
Telephone:  (301) 443-4703
FAX:  (301) 443-3891
Email:  jweeda@willco.niaaa.nih.gov

AUTHORITIES AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance No. 93.279 and 93.273.  Awards are made under
authorization of the Public Health Service Act, Section 301, and
administered under PHS policies and Federal Regulations at 42 CFR 52
and 45 CFR Part 74.  The United States Department of Agriculture has
transferred funds under authorization of the Food, Agriculture,
Conservation and Trade Act of 1990, PL 101-624, Section 1602(a) (7
USC 1421) and, the National Agriculture Research, Extension and
Teaching Policy Act of 1977 as Amended, Section 1402 (7 USC 3101).
This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or Health Systems Agency
review.

Grants must be administered in accordance with the Public Health
Service Grants Policy Statement (DHHS Publication No. (OASH)
82-50-000 GPO 0017-020-0090-1 (rev. 4/94).

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-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 routing 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.

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