Full Text CA-95-001


NIH GUIDE, Volume 24, Number 4, February 3, 1995

RFA:  CA-95-001

P.T. 34, FC

  Disease Prevention+ 
  Disease Control+ 

National Cancer Institute

Letter of Intent Receipt Date:  March 3, 1995
Application Receipt Date:  April 27, 1995


The National Cancer Institute (NCI), through the Division of Cancer
Prevention and Control, Cancer Control Science Program, Special
Populations Studies Branch, invites applications for a cooperative
agreement award to continue building a vigorous cancer prevention and
control outreach program for Black American communities.

The program, entitled National Black Leadership Initiative on Cancer
(NBLIC), has the immediate goals of involving community leaders in
building new and maintaining previously established community cancer
control coalitions, and addressing the barriers that limit Black
Americans' access to quality cancer prevention, control, and
treatment services.  It is anticipated that such activities will lead
to accomplishment of NBLIC's long-range goal of reducing cancer
incidence and mortality rates, and increasing survival rates among
Black Americans.  Intermediate goals include improvements in
knowledge and behavior of Black Americans about the prevention and
early detection of cancer.


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 RFA,
National Black Leadership Initiative on Cancer, is related to the
priority area of cancer.  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, U.S. Government Printing Office,
Washington, DC 20402 (telephone 202/783-3238).


Applications may be submitted by cancer centers, hospitals and
clinics, institutions of higher education (public or private) such as
colleges, universities, schools of public health, nursing, health
science centers, and eligible agencies of the Federal Government.
Applicant institutions should have substantial involvement with the
black community, providing a range of health care, health education,
and/or disease prevention services.

Collaborative applications are encouraged.  Among collaborators, one
must be designated as the lead applicant and assume responsibility
for conduct of the project.  Foreign organizations are not eligible
to apply, and applications from domestic organizations may not
include international components.


Administrative and funding support will be provided via the
cooperative agreement (U01), an assistance mechanism in which
substantial NCI scientific/programmatic involvement with the awardee
is anticipated.  Under the cooperative agreement, NCI's purpose is to
support community-based activity by jointly cooperating with the
award recipient in a partner role, but not to assume direction, prime
responsibility, or a dominant role in the project.  Details of
responsibilities, relationships, and governance of the project that
results from this RFA are discussed below under the section "Terms
and Conditions of Award."

The total project period for applications submitted in response to
this RFA may not exceed four years.  The anticipated start date for
the award is September 1995.  At this time,  NCI has not determined
whether, nor how, this solicitation will be continued beyond the
present RFA.


Approximately $1.5 million in total costs (direct and indirect) will
be committed each year for four years specifically to fund the one
award that results from this RFA.



In 1986, the National Cancer Advisory Board (NCAB) expressed concern
about the heavy burden of cancer on the Black American community and
how the tobacco and alcohol advertisements targeting that community
serve to exacerbate the burden.  To address their concern, the NCAB
formed an ad hoc national planning committee comprised of Black
American business, education, and health professionals to develop an
operational plan for increasing community awareness about cancer.
The work of that committee led to the formation of a conceptual
organizational framework which was later named the National Black
Leadership Initiative on Cancer and implemented in 1989.

Since its inception, NBLIC has facilitated a wide variety of
activities to promote cancer control and prevention among Black
Americans.  The program has developed strong networking relationships
with national, state, local, grassroots, and special interest
organizations across the United States.  A major focus for NBLIC is
the establishment of community-based cancer prevention and control

Project Rationale

Data continue to show that Black Americans bear a disproportionate
burden of cancer, marked by increasing mortality rates for many
cancers in contrast to the trends among whites.  The extent to which
blacks experience higher cancer mortality is striking.  Not only do
blacks have higher mortality rates than whites, but these rates are
also increasing faster.  Further, mortality rates which are
decreasing for whites are not decreasing as quickly for blacks and,
for a few cancers, are still increasing, i.e., larynx, oral cavity,
pancreas, colon and rectum, and leukemia.

The age-adjusted incidence rate for all cancers and both sexes
combined increased in both blacks and whites by about 22 percent
between 1973 and 1991.  However, the magnitude of the overall cancer
incidence rate among blacks was nearly 8 percent higher than among
whites in 1991.

In 1991, the age adjusted incidence rate for all cancers combined was
405 per 100,000.  Rates are highest in black men (598 per 100,000 and
lowest in black women (334 per 100,000).

In 1991, the age adjusted mortality rate for all cancers was 173 per
100,000.  Mortality rates are highest in black men (317 per 100,000).
Rates are lowest in white women (141 per 100,000).

Five-year relative survival is higher among women than men and whites
than blacks for all sites combined and all sites except lung and
bronchus.  Exclusion of lung and bronchus results in an almost 10
percentage point increase in survival for white and black men, and a
4 to 5 percentage point increase for white and black women, clearly
illustrating the large impact of lung and bronchus on the cancer
burden within the general population, especially among men.
Improvements in survival since 1974-76 have been significant for all
groups except black women although the amount of improvement is

Black Americans have disproportionately larger numbers of blue-collar
workers, possibly increasing their risk of certain
occupationally-related cancers.  Fewer Black Americans have adequate
health insurance coverage, thereby decreasing the likelihood that
they will have access to early detection methods or state-of-the-art
treatment.  Certain culturally-based factors, such as unhealthy
dietary habits and negative attitudes toward health and health care,
have been identified and linked to cancer within the Black American

Ethnic and cultural differences involving dietary patterns, alcohol
use, and sexual and reproductive behaviors can provide clues to
factors involved in the development of cancer.  Socioeconomic factors
such as lack of health insurance or transportation can impede access
to care, and lead to late diagnosis and poor survival.

Objectives and Scope

Recognizing that there are numerous health interventions being
conducted in the black community by local and other federal funding
agencies, this RFA will support activities that identify and fill
gaps in current cancer prevention and control programs, and evaluate
the efficacy of existing intervention strategies.  Guided by the
results of those activities, the award recipient develops and
implements improved intervention strategies, more effective community
program, and stronger cancer control coalitions.  Measurable
improvements are expected in knowledge, attitude, and behavior of
Black Americans about the prevention and early detection of cancer.

NBLIC is national in scope targeting Black American males and females
of all ages.  Applicants are strongly encouraged to propose a plan
for restructuring NBLIC geographically given the wide distribution of
Black Americans in the western and plains states and the dense
populations of those in the southern states.  The plan should include
a description of an efficient organizational structure through which
the project will be managed, and programmatic approaches developed
for reaching Black Americans in urban, suburban, and rural settings.
It is suggested that concepts such as community organizing, and
community wellness be considered, among others, as possible models
for expanding and enhancing NBLIC coalitions established during
previous years and to build new ones. (See references)

The NBLIC project will involve three overlapping phases. Planning and
Development (Phase I); Program Implementation and Evaluation (Phase
II); and, Data Analysis and Reporting (Phase III).  Although
technical assistance will be provided by NCI (see Terms of
Cooperation, below), the awardee is responsible for carrying out all
aspects of each phase.  The specific elements of each phase may vary
relative to the awardee's level of involvement with NBLIC.  For
example, during Phase I, a continuing awardee might be primarily
concerned with project refinement and enhancement in lieu of the
developmental measures that would dominate this phase for a new
awardee.  Nonetheless, the following will be generally applicable:

A.  Phase I: Planning and Development

o  Develop a comprehensive, strategic project plan with time
schedules and milestones to address all key aspects of the project.
The plan should address such things as:  the identity of target
communities, methods to identify and recruit organizations and local
leaders, strategies to establish and maintain productive
relationships with cancer-related groups, methods for communities to
identify their cancer control needs and design activities to meet
these needs, ways to ensure area-wide program support and visibility,
strategies for disseminating project findings, plans to provide on
and off-site technical assistance, and methods for quality assurance.

o  Develop and implement a program management plan that includes a
description of the program structure, roles and responsibilities of
key staff, and a communication system for the regular exchange of
information and ideas between key staff members and local area
leaders, organizations, and coalitions.

o  Develop a plan for the development and dissemination of program
messages, materials, and products.  This will include target groups,
goals and objectives, methods of development, distribution, and
evaluation.  For example, public media campaigns and patient
education materials may be planned in response to
community-identified needs.

o  Develop a detailed evaluation plan that includes process, outcome,
and cost-effectiveness measures.  See "Phase II:  Implementation and
Evaluation" below.

o  Develop a long range plan for continued community activity and
institutionalization of this outreach initiative after the expiration
of the four-year cooperative agreement.  The plan may include such
things as obtaining in-kind contributions, fostering volunteerism,
pursuing cost-containment techniques, and establishing affiliations
with health care provider groups and non-profit organizations.

B.  Phase II: Implementation and Evaluation

During the second phase of the project, beginning 2-12 months from
award, implementation and evaluation of outreach activities will
begin according to the program plans developed in Phase I.  Progress
towards planning, implementation, evaluation, and documentation will
be measured by milestones.  Coalitions and outreach activities will
be monitored for quality and outcome effects.

The development of consortia or coalitions to achieve the objectives
of this RFA is encouraged.  If a consortium or coalition is proposed,
a clear delineation of roles and administrative procedures must be
outlined in the application.  If the budget request includes support
for more than one unit, policies and procedures for financial and
program management must be outlined in the application.

A significant aim of NCI is to improve the overall national cancer
prevention and control effort by creating cohesion among cancer
programs it sponsors, and other public and private health
organizations.  To this end, applicants should strive to establish
relationships with relevant cancer programs (e.g., cancer information
programs, facilities providing cancer care, local components of
national cancer-related organizations, and cancer or other incidence
registries) in areas where they exist.

1.  Project Evaluation

The NCI will only support projects which have well-developed,
comprehensive evaluation plans.  The evaluation plan must be
conceptually and procedurally integrated with the overall project.
It must connect implementation and outcome and specify a time frame
for conducting all evaluation activities.  The evaluation plan must
describe the selection and development of sound measures and
instruments for data collection.  The application must include
detailed and clearly written descriptions of process and outcome
evaluation.  Examples of questions that the NBLIC evaluation design
should reflect include the following:

o  Did NBLIC build and maintain effective coalitions?
o  What explains coalition effectiveness?
o  Did NBLIC achieve changes likely to lead to reduced cancer
incidence and mortality?
o  What explains changes in NCI cancer prevention and control
o  What about NBLIC is replicable?

It is anticipated that the awardee will formulate additional
evaluative type questions and/or amend the above to better explain
key facets of NBLIC project activity.

2.  Process Evaluation

Process evaluation facilitates the replication of effective projects.
It consists of the periodic monitoring of project implementation to
document what actually was being done and to facilitate project
adjustments or corrections when needed over the course of the
project.  It involves the collection of both quantitative and
qualitative data that permit a description of the formation and
ongoing functions of community coalitions as well as the project as a

Process evaluation may include descriptions of the methods used to
form structure, and maintain community coalitions; the breadth of
coalition membership and the interaction patterns of organizations
and individuals in coalitions (e.g., patterns of communication,
conflict, conflict resolution, coordination, cooperation, and
collaboration); methods used to inform and involve the community in
cancer control outreach activities; ways used to sustain trust and
credibility for the program, and program costs.  Process evaluation
may also include detailed descriptions of project activities and
their tracking.

3.  Outcome Evaluation

Outcome evaluation consists of assessing whether the project was
effective in meeting its objectives in ways that will lead to project
goals.  The design of the outcome evaluation and the resulting data
should be based on clear and measurable indicators of progress toward
project goals.  The outcome evaluation design should be rigorous
enough to result in valid conclusions concerning the effectiveness
and replicability of the project.

Baseline data pertaining to the target area are essential for a
meaningful outcome evaluation.  Proposed baseline data (e.g., cancer
measures of the availability and utilization of cancer control
services, cancer rates, tobacco use rates, and indicators of
knowledge about the prevention and early detection of cancer) and
methods for obtaining data must be provided.  Additionally, plans for
the periodic collection of the same information must be described.
The importance of external resources and the likelihood of their
availability should be estimated.  While awardee researchers should
obtain as much baseline data as possible in the process of the
preparation of the cooperative agreement application, refinement and
development of key elements can occur at the beginning of the project

The PI funded under this cooperative agreement is responsible for
collecting core data that are comparable across project sites.  The
definition of these data will be jointly decided by the Steering
Committee during the first year of the project (see SPECIAL
REQUIREMENTS, Terms of Cooperation).  These data may include, but are
not limited to:  measures of coalition effectiveness; characteristics
of coalitions and their numbers; descriptions of planned activities;
changes in utilization of cancer control services; and, extent of
media coverage and involvement.

C.  Phase III:  Data Analysis and Reporting

In conducting the analysis, researchers should consider features of
the setting (e.g., geographic, social, economic, demographic, etc.)
which may either facilitate or impede implementation of the project.
In addition, recommendations should be made concerning the potential
for generalization of the project to other rural settings.

Although this phase will overlap certain periods of Phase II, it is
anticipated that data collection, analysis, and reporting will be
most intense during the last two years of the four-year award.  This
is also the period for special emphasis on the dissemination of
program findings.

The awardee institution retains custody and primary rights to the
data consistent with current DHHS, PHS, and NIH policies.  However,
NCI will have access to all data and may periodically review the
awardee's data management procedures.

In addition to required annual progress reports, the awardee will
provide semi-annual reports and additional information as requested
by the NBLIC Program Director.  A suggested format for these reports
will be provided by the NBLIC Program Director.  NCI program staff
will review the progress of NBLIC through consideration of the annual
reports, site visits, and reports from collaborative
institutions/organizations.  Special intermittent reports or
additional information may be required for purposes involving
programmatic expedience.  Examples of information that should
typically be included in the reports are the following:

o  Community Coalitions - List the number and composition of
coalitions with a breakout of those established by NBLIC; list and
describe coalition activities and results; list and describe
community resources that are available to coalitions; list and
describe the resources that may be needed and how these would be
allocated and managed to enhance coalition activity.

o  Education, Health Advocacy and Research - Describe the level of
involvement with health advocacy type activities (e.g., anti-
tobacco/smoking campaigns, and cancer screening programs) and how the
information disseminated by NBLIC staff parallels NCI endorsed
research findings.

o  Cancer Survivor Support Groups - List the number and describe the
types of such groups with a breakout of those established by NBLIC;
describe the frequency and place of support group meetings; provide
examples of agenda items or topics discussed and a brief profile of
the leader(s); describe how these groups are supported by NBLIC.

o  Community Leadership - List the number of community leaders
recruited, provide a profile of each, and describe the role each
performs in furthering the project agenda.

Reports should also describe any untoward effects of NBLIC activities
and how these were/are/will be addressed or resolved.


Terms and Conditions of Award

The following special Terms and Conditions of Award will be
incorporated into the award statement and provided to the
institutional official at the time of award.  They are in addition to
and not in lieu of otherwise applicable OMB administrative
guidelines; HHS Grant Administration Regulations at 45 CFR part 74
and 92, and other HHS, PHS, and NIH Grants Administration policies.

The administrative and funding instrument to be used for this project
will be a cooperative agreement (U01), an assistance mechanism in
which substantial NCI scientific/programmatic involvement with the
awardee is anticipated during performance of the activity.  However,
the awardee has the dominant role and prime responsibility for each
activity and the project as a whole.

The inability of the awardee to meet the performance requirements set
forth in the Terms and Conditions of Award in the RFA, or significant
changes in the level of performance, may result in an adjustment of
funding, withholding of support, suspension or termination of award.

A.  Awardee Rights and Responsibilities

o  Plan, develop, implement, evaluate, and direct all aspects of the

o  Publish project results during Phase III.

o  Define the role and responsibilities of the NBLIC Steering
Committee, select its members and provide funds for their travel and
appropriate meeting-related expenses.

o  Apprise the NCI Program Director of plans to develop printed
materials and media messages intended for programmatic purposes.

o  In addition to required annual progress reports, provide semi-
annual reports and additional information as requested by the NBLIC
Program Director.

o  Collect, analyze, publish, and present data and program findings;
retain custody of and have primary rights to the data developed under
this award subject to Government rights of access consistent with
current HHS, PHS, and NIH policies.

o  Ensure the representation of appropriate NBLIC project staff at
key meetings.

o  Develop a long-range plan for possible continued community
activity and institutionalization of NBLIC after expiration of the
four-year cooperative agreement.  The plan may include such things as
obtaining in-kind contributions, fostering volunteerism, pursuing
cost-containment techniques, and establishing affiliations with
health care provider groups and non-profit organizations.

B.  NCI Program Director Responsibilities

o  Provide assistance to the awardee regarding the quality and type
of data to be used and its potential value to the project, and shall
periodically review the use of such data and assist in determining
further use.

o  Assist the awardee with planning project activities and
establishing priorities; assist in establishing and maintaining
effective communication channels.

o  Confer with the awardee regarding staffing needs; advise and
assist in the selection of key staff; may approve or disapprove key

o  Serve as a member of the NBLIC Steering Committee and report to

o  Assist in recruiting specialized technical assistance that is
deemed essential to the development and distribution of culturally
competent program communication messages and materials.

o  Assist in publishing data findings and process activities;
participate in writing and preparing publications in accordance with
NIH staff publication policies; retain authority to approve
publications and printing costs exceeding $25,000 for a single

o  Coordinate special meetings to address NCI priority issues.

C.  Collaborative Responsibilities

A NBLIC Steering Committee, composed of the Principal Investigator
and the awardee's NBLIC Project Manager, NCI, NBLIC Program Director,
and community leaders such as those currently serving as NBLIC
regional chairpersons, will be established to provide guidance and
support for program activities and to identify project-wide needs and
resources.  The committee will select a chairperson from among its
ranks other than the NCI member.  As needed, the NBLIC Steering
Committee may establish subcommittees, such as a data and evaluation
subcommittee, to focus on special issues.

D.  Arbitration

Any disagreement that may arise on programmatic matters (within the
scope of the award), between the award recipient and NCI may be
brought to arbitration.  An arbitration panel will be composed of
three members -- one selected by the project's advisory committee
(with the NCI Program Director not voting) or by the awardee in the
event of an individual disagreement, a second member selected by the
NCI Program Director, and the third member selected by the two prior
selected members.  This special arbitration procedure in no way
affect the awardee's right to appeal an adverse action that is
appealable in accordance with PHS regulations at 42 CFR part 50,
subpart D and HHS regulation at 45 CFR part 16.


It is the policy of the National Institutes of Health (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.

Due to the nature of this solicitation, the requirement for inclusion
of minorities is satisfied.  Applicants must still describe the
proposed population, including gender composition operation and
outreach plans.

All investigators proposing research involving human subjects should
read the "NIH Guidelines on the Inclusion of Women and Minorities as
Subjects in Clinical Research," which was reprinted in the Federal
Register of March 28, 1994 (59 FR 14508-14513) to correct typesetting
errors in the earlier publication, 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.


Prospective applicants are asked to submit, by March 3, 1995, a
letter of intent that includes a descriptive title of the proposed
project, name, address, and telephone number of the principal
investigator, identities of other key personnel and participating
institutions, and number and title of the RFA in response to which
the application is being submitted.

Although a letter of intent is not required, is not binding, and does
not enter into the review of subsequent applications, the information
allows NCI staff to estimate the potential review workload and to
avoid conflict of interest in the review.  The letter of intent is to
be sent to Frank E. Jackson, NBLIC Program Director, at the address
provided under INQUIRIES.


The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for this award.  These forms are available at most local
institutional offices of sponsored research; from the Office of
Grants Information, Division of Research Grants, National Institutes
of Health, 5333 Westbard Avenue, Room 449, Bethesda, MD 20892,
telephone 301/584-7248.

The RFA label available in the PHS 398 (rev. 9/91) application form
must be affixed to the bottom of the face page of the application.
Failure to use this label could result in delayed processing of the
application such that it may not reach the review committee in time
for review.  In addition, the RFA title and number must be typed on
line 2a of the face page of the application form and the "YES" box
must be marked.

Submit a signed, typed original of the application (without
appendices), including the Checklist, and three signed, exact, clear,
and single-sided photocopies, in one package to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At time of submission, two additional copies of the application must
also be sent to:

Ms. Toby Friedberg
Division of Extramural Activities
National Cancer Institute
6130 Executive Boulevard, Room 636
Rockville, MD  20852

It is important to send these copies at the same time that the
original and three copies are sent to DRG; otherwise, the NCI cannot
guarantee that the applications will be reviewed in competition with
other applications received on or before the designated receipt date.

Applications must be received by April 27, 1995.  If an application
is received after that date, it will be returned to the applicant
without review.  The Division of Research Grants (DRG) will not
accept any application in response to this RFA that is essentially
the same as one currently pending initial review, unless the
applicant withdraws the pending application.  The DRG 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 an application must include an
introduction addressing the previous critique.

Include the following additional information on the application form
PHS 398 continuation pages.

o  Document the applicant institution's experience with community-
based health interventions, and describe the management systems that
were effective in organizing the effort, monitoring project
resources, and working with coalitions.

o  Attest to the adequacy and availability of facilities to be used
for the project, such as office space and equipment.

o  Describe key personnel and their proposed duties as well as their
current duties with the applicant institution.  The level of effort
of personnel on this project should reflect the commitment of the
individual and the applicant institution to ensuring organizational
efficiency and maximum resource utilization.

Applicants should include an appropriately justified budget for each
12 month segment for a total of four years of funding, and describe
the fiscal plan that will provide support for coalition activities,
(e.g., meetings, mailings, programs, etc.).

Travel estimates for the four year project period should include up
to four meetings for the Steering Committee during the first year and
one annual meeting for each group thereafter in Bethesda, MD.


Upon receipt, applications will be reviewed for completeness by the
Division of Research Grants and responsiveness by the NCI.
Incomplete and non-responsive applications will be returned to the
applicant without further consideration.

Applications that are complete and responsive to the RFA will be
evaluated for scientific and technical merit by an appropriate peer
review group convened by NCI in accordance with the review criteria
stated below.  As part of the initial merit review, a process
(triage) may be used by the initial review group in which
applications will be determined to be competitive or non-competitive
based on their scientific merit relative to other applications
received in response to the RFA.  Applications judged to be
competitive will be discussed and assigned a priority score.
Applications determined to be non-competitive will be withdrawn from
further consideration and the principal investigator/program director
and the official signing for the applicant organization will be
promptly notified.

The second level of review will be performed by the National Cancer
Advisory Board.  This Board considers the special needs of NCI and
the priorities of the National Cancer Program.

Review Criteria

Applications will be judged primarily on evidence of an understanding
of the Black American community and its cancer control needs; the
ability to access and obtain participation of the community, recruit
community leaders, establish coalitions, and collaborate with other
organizations; qualifications of the investigators, including
community outreach experience, cultural competence, and cancer
control and communications expertise; capability to perform the work
proposed; and a demonstrated willingness to work together with
collaborating entities and NCI staff.

The following criteria will be used in the review:

o  Comprehensiveness, feasibility, and consistency of the proposed
project plan with the goals and objectives of the RFA, and the extent
to which the application demonstrates originality and an
understanding of cancer control outreach activities as well as
community coalition development;

o  Rationale for selection of the targeted geographic area and
documentation of its cancer control needs including cancer-related
risk factors, access and utilization of health care services, and
cancer rates;

o  Adequacy and soundness of the staffing and project management
plans, including evidence of the capability, experience, and
qualifications of the awardee and cooperating institution's technical
staffs to implement the project successfully and a good overall
balance of the program team in relation to the objectives of the

o  Appropriateness of the implementation plan and the extent to which
it demonstrates sensitivity to cultural and socioeconomic factors in
the community, including evidence that these factors are significant
targets of inclusion in community coalitions;

o  Evidence of program linkages to existing relevant federal, state,
and local cancer control plans and activities in target communities,
as well as a strategy for improving existing plans and stimulating
their implementation;

o  Adequacy, appropriateness, feasibility, and comprehensiveness of
the evaluation plan, including sufficient allocation of resources;

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

o  Feasibility of the project within the resources and time frames
proposed; appropriateness of the proposed budget and duration in
relation to the proposed initiative; and inclusion of specific
written agreements with cooperating institutions, including those
agencies that may be providing services and/or the settings for these


The anticipated award date is September 1995.  Applicants will
compete for funding based on the quality and merit of the proposed
outreach program as determined by peer review.

Cooperative agreement applications recommended by the National Cancer
Advisory Board will be considered for award based upon (a) scientific
and technical merit; (b) program balance, including in this instance,
sufficient compatibility of features to make a successful
collaborative program a reasonable likelihood; and (c) availability
of funds.

As with research grants, interim and terminal progress reports must
be submitted to the NCI in accordance with the current PHS Grants
Policy Statement.  The interim progress reports will be a part of the
noncompeting continuation application and should include the
following information:  (a) a brief statement and critique of
progress toward achieving originally stated objectives; (b) a
description or listing of related issues, positive or negative,
considered to be significant by the awardee, and (c) plans for the
next funding period.  Terminal progress reports must be submitted
within 90 days after the end of the project and should include items
(a) and (b) above.


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

Direct inquiries regarding programmatic issues to:

Frank E. Jackson
Division of Cancer Prevention and Control
National Cancer Institute
Executive Plaza North, Room 240D
Bethesda, MD  20892
Telephone:  (301) 496-8589
FAX:  (301) 496-8675

Direct inquiries regarding fiscal matters to:

Catherine E. Blount
Grants Management Officer
National Cancer Institute
6120 Executive Boulevard, Room 243
Bethesda, MD  20852
Telephone:  (301) 496-7800 Ext. 262


This program is described in the Catalog of Federal Domestic
Assistance No. 93.399.  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78- 410, as
amended by Public Law 99-158, 42 USC 241 and 285) and administered
under PHS grants policies and Federal Regulations 42 CFR Part 52 and
45 CFR Part 74.  This program is not subject to the intergovernmental
review requirements of Executive Order 12372 or Health Systems Agency

The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and promote the non-use of all tobacco products.  This
is consistent with the PHS mission to protect and advance the
physical and mental health of the American people.


1.  National Cancer Institute, SEER Cancer Statistics Review
1973-1991, NIH Publication No. 94-2789

2.  Gail MH: A Review and Critique of Some Models Used in Competing
Risk Analysis,  Biometrics 31: 209-222, 1975.

3.  National Center for Health Statistics.  Health, United States,
1993, DHHS Publication No. (PHS) 94-1232. Washington, DC: U.S.
Department of Health and Human Services, 1990.

4.  Bennett, C.E.: The Black Population in the United States: March
1992, Bureau of the Census, U.S. Department of Commerce

5.   Hunkeler, E.F., et al.: Richmond Quits Smoking: A Minority
Community Fights for Health, Health Promotion at the Community Level,
Sage Publications, Newburg Park, CA, 1990

6.   Jenkins, S.: Community Wellness: A Group Empowerment Model For
Rural America, Journal of Health Care for the Poor and Underserved,
Vol. 1, No.4, Spring 1991


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