HEALTH DISPARITIES: LINKING BIOLOGICAL AND BEHAVIORAL MECHANISMS WITH SOCIAL AND 
PHYSICAL ENVIRONMENTS

Release Date:  November 4, 1999

RFA:  ES-00-004

National Institute of Environmental Health Sciences
National Institute on Aging
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institute of Child Health and Human Development
National Institute of Mental Health
National Institute for Occupational Safety and Health
Office of Behavioral and Social Sciences Research

Letter of Intent Receipt Date: January 25, 2000
Application Receipt Date: April 26, 2000

PURPOSE

The purpose of this solicitation is to foster multidisciplinary research that
will elucidate underlying mechanisms by which the interaction of social and
physical environments leads to health disparities. For purposes of this
Request for Applications (RFA), the physical environment includes physical
agents (e.g., radiation), chemical agents (e.g., pesticides) and biological
agents (e.g, pathogens, harmful algal blooms) to which individuals are
exposed in a multitude of settings, including home, school, and workplace.
The social environment includes individual and community-level
characteristics, e.g., socioeconomic status (SES), education, coping
resources and support systems, residential factors, cultural variables,
institutional and political forces such as racism and classism, familial
factors, and media influences.  The ultimate goal of this research is to
enhance our understanding of the causes and mechanisms responsible for
disparities in health among the U.S. population, especially between lower SES
and higher SES groups.  

This RFA will support research to strengthen the science base for achieving
the goals of the President"s Initiative to Eliminate Racial and Ethnic
Disparities in Health (see http://raceandhealth.hhs.gov/.)  The National
Institutes of Health (NIH) has identified as a special emphasis area research
related to health disparities.  This RFA is one part of a larger NIH and
Department of Health and Human Services (DHHS) effort.  Via this particular
initiative, the NIH seeks to clarify biological, social, and behavioral
processes that lead to health disparities stemming from the interaction of
social and physical environments and SES as a basis for ultimately developing
intervention strategies.  This RFA will not support applications in which the
social environment being examined is limited to individual lifestyle choices
or to access to and quality of health care (see Background).  Such variables
are appropriate to this RFA only when coupled to a broader context or array
of social environmental factors.  Applications submitted in response to this
RFA require collaborative efforts between social/behavioral scientists and
biomedical scientists and will not be limited by disease end points.  In
addition, applications must contain a Community Outreach and Education
Program (COEP, see Special Requirements) that incorporates strategies for
translating research findings into knowledge that can be used to improve
public health.    

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 RFA, "Health
Disparities: Linking Biological and Behavioral Mechanisms with Social and
Physical Environments," is related to one or more of the priority areas. 
Potential applicants may obtain a copy of "Healthy People 2000" at 
http://odphp.osophs.dhhs.gov/pubs/hp2000

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, 
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. Applications are required to have
collaborations between behavioral/social scientists and biomedical scientists
as key personnel to undertake the multidisciplinary objectives of this RFA. 
The roles of the collaborators must be clearly defined.  Applications that do
not have these collaborations will be considered non-responsive and returned
to applicants without review.

MECHANISM OF SUPPORT

All of the Institutes participating in this RFA will use the National
Institutes of Health (NIH) research project grant (R01) award mechanism. 
Responsibility for the planning, direction, and execution of the proposed
project will be solely that of the applicant.  The total project period for
an application submitted in response to this RFA may not exceed 5 years. The
earliest anticipated award date is September 29, 2000.

Requested amounts should not exceed $400,000 direct costs per year.  Awards
will be administered under NIH grants policy as stated in the NIH Grants
Policy Statement.  Future unsolicited competing continuation applications
will compete with all investigator-initiated applications and will be
reviewed according to the customary peer review procedures. 

FUNDS AVAILABLE

This RFA is a one-time solicitation.  The National Institutes of Health
(NIH)and the National Institute for Occupational Safety and Health
(NIOSH)intend to commit approximately $5,000,000 in FY 2000 to fund new
grants in response to this RFA.  It is anticipated that up to 10 awards will
be made.  An applicant may request a project period of up to 5 years and a
budget for direct costs of up to $400,000 per year, excluding facilities and
administrative (F&A) costs on consortium arrangements.  Because the nature
and scope of the research proposed may vary, it is anticipated that the size
of each award will also vary.  Awards pursuant to this RFA are contingent
upon the availability of funds for this purpose. Only applications that are
found to be of the highest scientific and technical merit will be considered
for funding and not all of the funding will be spent if there are not enough
highly meritorious applications.  Funding in future years will be subject to
the availability of funds.

RESEARCH OBJECTIVES
                    
Background

The disparity in health between socioeconomically disadvantaged individuals
and those more advantaged has existed for centuries and continues to this
day.  These health disparities (HD) may be defined as differences in disease
incidence, mental illness, morbidity and mortality that exist between
specific populations.  Disparities are most apparent and closely associated
among populations with varying levels of socioeconomic status (SES.) 
Significant evidence has demonstrated that a gradient exists between SES and
health status, with individuals of high SES having better overall health that
those of low SES.  The most striking health discrepancies result in shorter
life expectancy, as well as higher rates of most cancers, some birth defects,
infant mortality, asthma, diabetes, behavioral and affective disorders, and
cardiovascular disease. 

Exposure to toxic environmental and occupational agents can have different
effects in different persons of differing age, SES, ethnic background, gender
and genetic composition.  Some subsets of the population are inherently more
susceptible to cellular and genetic damage for a number of reasons, including
genetic susceptibility, nutritional status, other social or cultural
influences, or in the case of children, the vulnerability of developing
systems to environmental insult. 

In addition, occupational exposures are known to be distributed
differentially, and workers with specific biologic and/or SES characteristics
are more likely to have increased risk of work related diseases and injuries. 
Although the nature and magnitude of risks experienced by people of color
have not been thoroughly studied, data on occupational injury deaths indicate
that blacks have the highest rates per 100,000 workers compared with those of
whites and workers of other races.  High-risk populations have been
underserved by the occupational safety and health research community, with
the result that important unanswered questions remain about the profile of
hazards they face, the incidence of work-related injuries and illnesses, the
mechanisms of these injuries and illnesses, and the optimal approaches to
prevention.  Any or all of these factors may contribute to the health
disparities observed in socioeconomically disadvantaged and underserved
populations.

The relationships among social and physical environments, health, morbidity,
and mortality have been long and extensively documented.  While the overall
relationship of SES to mortality may attenuate in older ages, socioeconomic
position continues to be linked to the prevalence of disability and chronic
and degenerative diseases, including cardiovascular disease, many cancers,
and neurodegenerative diseases.  Low SES may result in poor physical and/or
mental health by operating through various psychosocial mechanisms such as
discrimination, social exclusion, prolonged and/or heightened stress, loss of
sense of control, and low self-esteem.  In turn, these psychosocial
mechanisms may lead to physiological changes such as raised cortisol, altered
blood-pressure response, and decreased immunity that place individuals at
risk for adverse health and functioning outcomes.  Not only may SES affect
health, but physical and mental health may have an impact upon the various
measures of SES (e.g., education, income/wealth, and occupation) over the
life course.

While access to health care may be an important variable that interacts with
SES to influence health disparities, this will not be a primary focus of this
RFA. Studies indicate that in industrialized nations having equal access to
quality health care, an SES gradient still exists in all cause morbidity and
mortality.  Countries that have universal health care systems, e.g., the
United Kingdom and Scandinavia, still demonstrate SES related health
disparities.  In fact, a landmark study conducted with British civil servants
as subjects ostensibly demonstrated a health outcome gradient in four income
groups. Although all workers had access to the same high quality health care,
each group had progressively more positive health outcomes with increasing
income level and job status.  What is noteworthy about this gradient is that
it exists across middle and upper income brackets of the British civil
servant occupation force.  These groups, although more affluent than lower
SES groups, did not have health outcomes as good as the group in the highest
SES category. 

Equally important is the notion that individual behavior and lifestyle
choices contribute to disparate health outcomes in lower SES strata.  There
have been recent data that indicate when individual behavior and lifestyle
choices, such as smoking, alcohol consumption, diet and exercise, are
corrected for, disparate health outcomes are still observed in lower SES
groups.  Such findings suggest that access to health care and individual
behavior and lifestyle choices are not the major determinants of SES-related
disparate health outcomes.  Indeed, these results shift research emphasis
toward examination of mechanisms by which social and physical environments
may interact with SES to produce health disparities.  For these reasons,
applications which limit the social environment being examined to individual
lifestyle choices or to access to and quality of health care will be
considered nonresponsive to this RFA and returned to the applicant without
review.  Such variables are appropriate to this RFA only when coupled to a
broader context or array of social environmental factors.  Investigators
interested in more extensive explorations of the role of individual lifestyle
choices or health care as related to health disparities are referred to more
relevant initiatives, e.g., Socioeconomic Status and Health Across the Life
course (https://grants.nih.gov/grants/guide/pa-files/PA-98-098.html)and
Understanding and Eliminating Minority Health Disparities
(https://grants.nih.gov/grants/guide/rfa-files/RFA-HS-00-003.html). 

INSTITUTE INTERESTS

The mission of the National Institute of Environmental Health Sciences
(NIEHS) is to reduce the burden of human illness and dysfunction from
environmental causes by understanding each of these elements and how they
interrelate.  The NIEHS achieves its mission through multidisciplinary
biomedical research programs, prevention and intervention efforts, and
communication strategies that encompass training, education, technology
transfer, and community outreach.  Programmatically, the NIEHS has a
distinguished track record at the forefront of developing innovative
community-based research and educational programs that impact low SES and
medically underserved communities.  The NIEHS Environmental Justice:
Partnerships for Communications Program establishes methods for linking
members of a community, who are directly affected by adverse environmental
conditions, with researchers and health care providers to ensure that the
community actively participates with researchers and health care providers in
developing responses and setting priorities for intervention strategies
(http://www.niehs.nih.gov/dert/programs/envjust.htm).  The Community-based
Prevention and Intervention Research Program (CBPIR) utilizes the same type
of partnership to implement culturally relevant prevention/intervention
activities in economically disadvantaged and/or underserved populations
adversely impacted by an environmental contaminant
(http://www.niehs.nih.gov/dert/programs/cbpir.htm). The NIEHS also supports
Developmental Centers at academic institutions which focus on environmentally
related health problems of underserved or underrepresented populations
(http://www.niehs.nih.gov/centers/overview/type/devl.htm).
Thus, the NIEHS is actively engaged in support of research that is relevant
to health disparities.

The National Institute on Aging (NIA) supports research that may encompass
all stages of the life cycle when the overall emphasis and intent of the
research is concerned with adult development and aging.  Research has shown
that lifestyle, economic, social, and environmental influences can have
profound effects on health and well-being in adulthood and old age. As part
of this RFA, the NIA will support meritorious applications that address SES
and health disparities of
older Americans with particular attention to: 1)incorporation of lifetime
exposures to the physical environment as they interact with SES in affecting
subsequent health trajectories, including studies that incorporate
residential and occupational histories to facilitate tracking of lifetime
environmental exposures, and 2)the interaction of SES with residential
choices of the elderly, and associated neighborhood environmental exposures
(e.g., violence, crime, transportation options, other amenities), including
analyses of small geographic area variations that account for historical
change (in terms of both their social and physical aspects).  See also Racial
and Ethnic Differences in the Health of Older Americans, 1997, National
Academy Press (http://www.nap.edu).

The National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS) leads the Federal effort on research into the causes, treatment, and
prevention of arthritis and musculoskeletal and skin diseases, the training
of basic and clinical scientists to carry out this research, and the
dissemination of information on research progress to improve public health. 
Rheumatic conditions, e.g., arthritis, systemic lupus erythmatosus (SLE), are
among the most prevalent chronic conditions in the United States, affecting
more than 40 million persons.  But not all population groups are equally
impacted. Epidemiological studies have documented marked differences in the
prevalence, morbidity and disability associated with specific rheumatic
diseases in Native American, Hispanic, African American and Caucasian
populations. Socioeconomic, demographic, cultural, immunogenetic,
environmental and clinical variables may all play a role in the presentation
and progression of disease.  But the relative importance of intrinsic and
extrinsic factors differs for the onset compared to progression and disease
outcome in these populations. Hispanic and African American SLE patients have
more severe disease at the time of presentation than Caucasian patients.  In
general, disease activity in the early stages of the disease is more severe
among minority female patients than among Caucasians.  Recent studies suggest
that genetic and ethnic factors appear to be more important than
socioeconomic determinants in influencing disease activity at the time of
disease onset.  However, socio-behavioral factors play an increasingly
important role in ethnic disparities after onset and may lead to a poorer
prognosis in minority populations.  The latter is important because it is
possibly amenable to more aggressive intervention. 

The National Institute of Child Health and Human Development (NICHD) seeks to
assure that every individual is born healthy, is born wanted, and has the
opportunity to fulfill his or her potential for a healthy and productive life
unhampered by disease or disability.  In pursuit of this mission, the NICHD
conducts and supports laboratory, clinical, sociological/behavioral and
epidemiological research on the reproductive, neurobiologic, developmental,
and social/behavioral processes that determine and maintain the health of
children, adults, families, and populations.  Integral to the overall mission
of the NICHD is the Institute"s mandate to take a developmental approach to
consider these processes as they lead from one developmental stage to another
-- starting before, into, and through conception, pregnancy, birth, infancy,
childhood, adolescence and adulthood through the reproductive years.  Thus,
an essential part of this research is to understand the origins and
accumulation of influences on individuals that would modify their
developmental trajectories over the life course and that would lead to health
disparities through these stages of development and into older ages.  The
NICHD will support applications that have an emphasis on population movement
and distribution, family behavior and/or socioeconomic neighborhood
characteristics as major influences regulating physical environments that
produce health disparities.

The National Institute of Mental Health (NIMH) supports research that seeks
to eliminate the effects of disparities that impinge on the mental health
status of all Americans, including women, children, elderly people, and
ethnic/cultural minority groups.  NIMH research investments in basic brain
and behavioral science have contributed to efforts to reduce the incidence
and burden of mental illness.  However, there remains a need for scientific
research that can tease apart the influences, interactions, and processes of
biological, genetic and socioenvironmental factors on the patterns of
incidence of mental disorders that reflect disparities.  Examination of risk
and protective factors, both behavioral and biological, that mediate or
moderate mental health disparities is of great importance and interest. 
Moreover, an abundance of epidemiological data has established that mental
disorders and medical conditions are frequently co-morbid.  The suffering
experienced by individuals as a result, and the cost to the nation in lost
productivity and health expenditures, is magnified well beyond the suffering
and costs associated with individual categories of disorder alone.  While the
data in some areas of co-morbidity are stronger than in others, relatively
little is known about role and processes of environmental risk factors.  

The National Institute for Occupational Safety and Health (NIOSH) supports
research to identify and investigate the relationships between hazardous
working conditions and associated occupational diseases and injuries, to
develop more sensitive means of evaluating hazards at work sites, as well as
methods for measuring early markers of adverse health effects and injuries,
to develop new protective equipment, engineering control technology, and work
practices to reduce the risks of occupational hazards, and to evaluate the
technical feasibility or application of a new or improved occupational safety
and health procedure, method, technique, or system.  In 1996, the NIOSH and
its partners in the public and private sectors developed the National
Occupational Research Agenda (NORA) to provide a framework to guide
occupational safety and health research into the next decade -not only for
NIOSH, but also for the entire occupational safety and health community.  The
Agenda identifies 21 research priorities and reflects consideration of both
current and emerging needs.  One of these priority areas is Special
Populations at Risk which was chosen because certain populations of workers
are more likely to experience increased risks of diseases and injuries in the
workplace as a result of biologic, social, and/or economic characteristics
such as age, race, genetic susceptibility, disability, language, literacy,
culture, and low income. Specific directed efforts are therefore needed to
prevent work-related diseases and injuries in these special populations. 
 
The mission of the Office of Behavioral and Social Sciences
Research (OBSSR) is to stimulate behavioral and social sciences research
throughout NIH and to integrate these areas of research more fully into other
disciplines of the NIH health research enterprise, thereby improving our
understanding, treatment, and prevention of disease.

RECENT PROGRESS

Over the past year the NIEHS and other NIH Institutes have undertaken a
number of activities to address the task of eliminating health disparities
that are influenced by SES. These activities include: 

o  three regional two and one-half day workshops in Oakland, CA, 1/99,
Baltimore, MD, 5/99 and Chicago, IL, 7/99, with the goal of developing a
research agenda, 
o  co-sponsorship of the New York Academy of Sciences Conference in Bethesda,
MD entitled: Socioeconomic Status and Health in Industrialized Nations:
Social, Psychological and Biological Pathways, 5/99, 
o  a Concept Forum on SES and HD on the NIH campus in Bethesda,
o  the multi-agency sponsored Program Announcement entitled Socioeconomic
Status and Health Across the Life course, 8/98.
https://grants.nih.gov/grants/guide/pa-files/PA-98-098.html
o  the multi-agency sponsored Program Announcement entitled Low Birthweight
in Minority Populations, 1/99.
https://grants.nih.gov/grants/guide/pa-files/PA-99-045.html.

Recommendations from these Health Disparities workshops provided the basis
for this RFA. Examples include:

Evaluation of the interconnection between the social environment, physical
exposures and psychosocial stress,

Analysis of multigenerational effects of social and physical exposures to
investigate links between exposures and health responses, 

Examination of the interaction between physical and psychological health,
both in terms of well-being and susceptibility, 

Assessment of the roles of the social environment (particularly SES),
physical environmental and occupational exposures, diet and obesity in
disease, 

Integration of research, education and service into studies of the biological
and social determinants of health disparities, 

Integration of qualitative and quantitative research methodologies into
studies of social and physical determinants of health disparities,
examination of the multiple pathways by which the interaction of social
(including SES) and physical environments influence health.

Workshop summaries can be found at: http://www.niehs.nih.gov/dert/gap.htm.

Objectives and Scope
 
This RFA will support research activities that elucidate the underlying
mechanisms by which the interaction of SES and physical and social exposures
lead to disparate health outcomes.  Applications considering the
contributions of physical or social environments in isolation, rather than
the interaction of physical and social exposures on health will be considered
nonresponsive and returned to the applicant without further review. While the
generation of new working definitions of SES, that consider multidimensional
interactions of education, income and occupational prestige is an important
concept, it is not a focus of this RFA, but is addressed in the multi-agency
sponsored Program Announcement entitled Socioeconomic Status and Health
Across the Life course 
(https://grants.nih.gov/grants/guide/pa-files/PA-98-098.html).   

The following areas illustrate suitable topics for research.  

o  Examination of the role of SES, environmental and/or occupational
exposures as determinants of health disparities over the life course.  What
is the role/interaction of social and physical environments at early stages
of development, e.g., gestation, childhood, or adolescence, that influence
health at later ages and of subsequent generations?

o  Analysis of the interaction between race/ethnicity, social and physical
environments and SES. An example of race/ethnicity, SES and physical
exposures may include political forces (e.g., segregation), compromising
physical exposures (e.g., lead or allergens) and neighborhood
characteristics,e.g., housing conditions.  Opportunities to study mechanisms
and genetic susceptibilities that contribute to disparate exposure related
outcomes present themselves over multiple developmental stages.

o  Assessment of the consequence of interactions between social constructs
(e.g., family, peers, neighborhoods and workplace environments) and physical
environments on health outcomes related to SES.  Socioeconomic status has
been most often characterized by the complex interplay between income,
education and occupation.  More recently, the concept of social capital has
been adopted as an additional measure of SES. Social capital encompasses
involvement in many types of societal institutions that act to positively
impact the function of communities.  Included as social capital units, but
not limited to, are: church memberships, civic organization memberships,
neighborhood organizations, individual stature within the community and the
listed social constructs/organizations.  Units of social capital for
communities could include the overall affluence of the community, the quality
and condition of schools, neighborhood housing, quality of recreational
facilities, etc. There is a paucity of data concerning the impacts of the
lack of social capital and physical environments on both individuals and
communities and their interaction with SES to influence health disparities.
Studies addressing these interactions may be considered.

o  Evaluation of the impact of workplace environments on workers within SES
strata.  Research is needed to determine the mechanisms by which SES and
conditions of work interact to determine the severity of emergent disease and
injury among these workers and within their communities.  Does the excess
occupational disease burden among low SES workers result from excess
exposures, differential susceptibility, and/or other factors including social
factors such as discrimination, language barriers, education or other
cultural characteristics?

o  Assessment of how SES, social and physical environments in individuals,
homes, the community and at the workplace interact with psychosocial
stressors to affect allostatic load and thus impact health.  Allostasis, the
body"s ability to adapt and adjust to environmental demands, has been
postulated as the mechanistic link between stress and health outcome. 
Therefore, the allostatic load represents the total burden of physical and
social exposures on an individual. Psychosocial stressors include, but are
not limited to, discrimination, lack of social capital, depression, low self-
esteem, hostility, job instability, unemployment, powerlessness, social
isolation, stress, and insecurity.  How do physical and social exposures
interact with psychosocial stressors and SES to generate adverse health
outcomes and functioning in low SES individuals? Studies that explore and
define mechanisms on how these factors contribute to health disparities are
encouraged.

o  Elucidation of multiple pathways by which SES influences social and
physical environments and consequently health.  There are limited data on
SES-related biological mediators of interactions between psychosocial
stressors and environmental exposures and their associated health outcomes,
e.g., altered hypothalamic-pituitary-adrenal axis function, altered
sympathetic and parasympathetic nervous system function, altered molecular
and cellular biology of organs, and altered immune responses.  The
development of biomarkers to link SES and social and physical environments is
encouraged, e.g., markers of folate metabolism, uracil-DNA, heat shock
proteins, etc.  Study of the intersection of these pathways may provide new
insights on mechanisms underlying the relationship between SES and exposure-
influenced health disparities.
o  Examination of multigenerational effects of the social environment and
physical exposures to investigate links between exposures and health
responses.  What is the interaction between physical and psychological
health, both in terms of well-being and susceptibility?

o  Study of social and physical environmental risk and protective factors and
processes that increase or decrease the likelihood of mental disorders,
singly or co-morbid with physical disorders, as well as studies of processes
that increase resilience to these disorders, including epidemiological
studies. 

o  To the extent that community organizations representing and serving the
disadvantaged are partners in research to address health disparities,
investigators may develop approaches to integrate research, education and
service into studies of the biological and social determinants of health
disparities.
 
o  Research on the development of strategies to reduce/eliminate health
disparities influenced by the interaction of the social and physical
environments.  The NIH and the NIOSH recognize that such strategies may
extend beyond the traditional confines of biomedical and behavioral research. 
Studies may be considered that have the capacity to identify and evaluate the
role of economic, social cultural, and policy incentives in eliminating or
reducing exposure related health disparities.

o  Identification of appropriate extant data sets that either contain or link
data on population health, social and physical environments.  A combination
of data sets and/or the use of geocode data to address contextual or
multilevel issues may be appropriate.  Similarly, researchers may want to use
survey data sets matched to death and/or birth records.  Micro-level rather
than aggregate analyses will be more appropriate for this initiative.  Cross
national data or data from other countries are appropriate if there is
demonstrated relevance to understanding of SES and health in U.S.
populations.  To address some questions, new data collection and new
methodologies may be required.  Whenever original data are collected, the
National Institutes of Health (NIH) expects grantees to make available
research data to the scientific community for subsequent analyses.  Data
archiving and sharing is appropriate and is encouraged.

SPECIAL REQUIREMENTS
 
o  Annual meetings, to be held in Research Triangle Park, NC, are planned for
the exchange of information among investigators. Applicants must budget
travel costs for all key personnel to attend these meetings in their
applications.
 
o  A Community Outreach and Education Program (COEP) is required for each
application.  The objective of the COEP is the translation of research
results into knowledge used to improve public health. As a part of this
effort, each grantee will define the community or population in which the
proposed COEP is to take place and develop productive outreach efforts which
are specifically designed to address SES-induced health disparities issues
and problems of greatest concern to that community or population. 
Communities are not necessarily defined by geographic boundaries.  In the
case of workplace projects, the community may be defined as the work
community rather than the community in which the workers live.  Workers and
management may constitute a workplace community, with impact on both workers"
families and on contiguous communities. Appropriate community organizations
may include labor unions or other workers organizations.  It is particularly
important to deal with COEP issues when they arise in a population which may
be more susceptible to insults, e.g., children or the elderly. Grantees are
encouraged to sponsor local efforts through community organizations and to
collaborate with other existing outreach programs in their area, e.g., those
supported by other NIH Institutes, other federal agencies (NIOSH, CDC,
ATSDR), state or local agencies or health departments. Appropriate activities
may include: 

1.  Continuing professional education that addresses SES, health disparities
and treatment and/or disease prevention programs, 
2.  Education (primary, secondary, and/or college), 
3.  Information dissemination including communication of research findings to
a diverse lay audience in culturally appropriate vehicles, 
4.  Community issue programs, public awareness seminars, or workshops etc.,
and/or
5.  Data archiving or other efforts to make data and analyses more accessible
and understandable by the lay public, including web-sites and other systems
that allow others to access, search, and down-load information, replicate
tabulations, or create their own tabulations.

COEP should be a logical outgrowth of the research focus of the application
and exhibit potential for mutual benefit due to interactions between
investigators and community members. Program staff listed below may be
consulted for additional information on COEP.  For reference purposes
applicants may examine similar COEP efforts conducted by NIEHS Environmental
Health Science Centers, such as those at the University of Washington
(http://www-apps.niehs.nih.gov/centers/public/coep/ctr-620.htm) or the University of
Medicine and Dentistry of New Jersey
(http://www-apps.niehs.nih.gov/centers/public/coep/ctr-840.htm).

COEP activities are a required component of each application submitted in
response to this RFA.  Applications lacking a COEP component will be
considered nonresponsive and be returned without further review. 
Approximately 10% of the budget should be used in support of outreach or
dissemination activities.

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 policy results from the NIH Revitalization Act of 1993
(Section 492B of Public Law 103-43).

All investigators proposing research involving human subjects should read the
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research," which was published in the Federal Register of March 28, 1994 (FR
59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No.
11, March 18, 1994, available on the web at:
https://grants.nih.gov/grants/guide/notice-files/not94-100.html

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of NIH 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 was published in the NIH Guide for
Grants and Contracts, March 6, 1998, and is available at the following URL
address: https://grants.nih.gov/grants/guide/notice-files/not98-024.html

Investigators also may obtain copies of these policies from the program staff
listed under INQUIRIES.  Program staff may also provide additional relevant
information concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit a letter of intent that includes a
descriptive title of the proposed research, the name, address, and telephone
number of the Principal Investigator, the identities of other key personnel
and participating institutions, and the number and title of the RFA in
response to which the application may be submitted.  Although a letter of
intent is not required, is not binding, and does not enter into the review of
a subsequent application, the information that it contains allows NIH staff
to estimate the potential review workload and avoid conflict of interest in
the review.

The letter of intent is to be sent to:

J. Patrick Mastin, Ph.D.
Scientific Review Administrator
Scientific Review Branch
Office of Program Operations
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD EC-24
111 T.W. Alexander Drive
Research Triangle Park, NC  27709
Telephone:  (919) 541-1446
Fax:  (919) 541-2503
Email: [email protected]

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 4/98) is to be used in
applying for these grants.  These forms are available at most institutional
offices of sponsored research and may be obtained from the Division of
Extramural Outreach and Information Resources, National Institutes of Health,
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone
301/710-0267, Email: [email protected].

The RFA label available in the PHS 398 (rev. 4/98) application form must be
affixed to the bottom of the face page of the application.  The RFA label and
line 2 of the application should both indicate the RFA number.  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 2 of the face page of the
application form and the YES box must be marked.

The sample RFA label available at: 
https://grants.nih.gov/grants/funding/phs398/label-bk.pdf
has been modified to allow for this change.  Please note this is in pdf
format.

Submit a signed, typewritten original of the application, including the
Checklist, and three 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)

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

J. Patrick Mastin, Ph.D.
Scientific Review Administrator
Scientific Review Branch
Office of Program Operations
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD EC-24
111 T.W. Alexander Drive
Research Triangle Park, NC  27709
Telephone:  (919) 541-1446
Fax:  (919) 541-2503
Email: [email protected]

Applications must be received by April 26, 2000.  If an application is
received after that date, it will be returned to the applicant without
review.
  
The Center for Scientific Review (CSR) 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
CSR will not accept any application that is essentially the same as one
already reviewed.  This does not preclude the submission of substantial
revisions of applications already reviewed, but such applications must
include an introduction addressing the previous critique.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness by the CSR and
responsiveness by NIH program staff.  Incomplete and/or 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 the NIEHS in accordance with the review criteria stated below. 
As part of the initial merit review, a process will be used by the initial
review group in which applications 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 the applications under review,
will be discussed, assigned a priority score, and receive a second level
review by the appropriate National Advisory Council.

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 the application in order to judge the likelihood that the proposed
research will have a substantial impact on the pursuit of these goals.  Each
of these criteria will be addressed and considered in assigning the overall
score, weighting them as appropriate for each application.  Note that the
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, an investigator 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 this study address an important problem? If the aims
of the application are achieved, how will scientific knowledge be advanced?
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? Does the applicant acknowledge potential problem areas and consider
alternative tactics?

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

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

(5) Environment: Does the scientific environment in which the 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?

In addition to the above criteria all applications will also be reviewed with
respect to the following:
 
o  Extent of utilization of multilevel studies, methods and contextual
analyses that tease apart host susceptibility, social and physical
environments and socioeconomic status (e.g., individual and neighborhood).

o  Demonstration of effective collaboration between social/behavioral
scientists and biomedical scientists to achieve programmatic goals, i.e.,
enhanced understanding of the behavioral and biological mechanisms
responsible for SES-related health disparities.

o  Appropriateness of proposed budget and duration in relation to the
project"s objectives.

o  Effectiveness of the project in establishing a Community Outreach and
Education Program that translates research results into knowledge that can be
used to improve public health. 
 
In addition to the above criteria, in accordance with NIH policy, all
applications will also be reviewed with respect to the following:

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

o  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.

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

Schedule

Letter of Intent Receipt Date: January 25, 2000
Application Receipt Date: April 26, 2000
Peer Review Date: June 2000
Council Review: September 2000
Earliest Anticipated Start Date: September 29, 2000

AWARD CRITERIA

Criteria that will be used to make award decisions include:

o  scientific merit (as determined by peer review)
o  availability of funds
o  programmatic priorities.

INQUIRIES

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:

Frederick L. Tyson, Ph.D. 
Scientific Program Administrator
Chemical Exposures and Molecular Biology Branch
Office of Program Development
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, 111 T.W. Alexander Drive, MD EC-21
Research Triangle Park, NC  27709
Telephone:  (919) 541-0176
Fax:  (919) 316-4606
Email:  [email protected]

Rose Maria Li, MBA, Ph.D.
Chief, Demography and Population Epidemiology
Behavioral and Social Research Program
National Institute on Aging
7201 Wisconsin Avenue, Suite 533
Bethesda, MD 20892
Telephone: (301) 496-3138 
Fax: 301-402-0051
Email: [email protected]

Susana A. Serrate-Sztein, Ph.D.
Director, Rheumatic Diseases Branch
National Institute of Arthritis and Musculoskeletal and Skin Diseases
45 Center Drive
MSC6500
Bethesda, MD 20892
Telephone: (301) 594-5032
Fax: (301) 480-4543
Email: [email protected]

V. Jeffery Evans Ph.D., J.D.
Demographic and Behavioral Sciences Branch 
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8B07, MSC 7510
Bethesda, MD 20892-7510
Telephone:  (301) 496-1176  
FAX:  (301) 496-0962
E-mail:  [email protected]

Cheryl A. Boyce, Ph.D.
Developmental Psychopathology and Prevention Research Branch
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6200
MSC 9617
Bethesda, MD 20892-9617
Telephone:  (301) 443-0848
Fax: (301) 480-4415
Email: [email protected]

Roy M. Fleming, Sc.D.
Director, Research Grants Program
National Institute for Occupational Safety and Health
1600 Clifton Road, N.E.
Building 1, Room 3053, MS D-30
Atlanta, GA  30333
Telephone:  (404) 639-3343
Fax:  (404) 639-4616
Email: [email protected]

Direct inquiries regarding fiscal matters to:

Carolyn B. Winters
Grants Management Specialist
Grants Management Branch
Office of Program Operations
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
Telephone:  (919) 541-7823
Fax:  (919) 541-2860
Email:  [email protected]

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No. 
93.3 93.113, 93.114, 93.115 and 93.866.  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 NIH
grants policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. 
This program is not subject to the intergovernmental review requirements of
Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant 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 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.

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)