Full Text ES-94-005


NIH GUIDE, Volume 23, Number 1, January 7, 1994

RFA:  ES-94-005

P.T. 34

  Information Science/Systems 

National Institute of Environmental Health Sciences

Letter of Intent Receipt Date:  March 01, 1994
Application Receipt Date:  April 01, 1994


The purpose of this program is to strengthen the NIEHS effort that
supports research aimed at achieving environmental equity for
socioeconomically disadvantaged and medically underserved populations
in the United States.  One goal of the NIEHS is to stimulate
investigative efforts that attempt to address questions related to
the influence of economic and social factors on the health status of
individuals exposed to environmental toxicants.

This component of the NIEHS environmental equity research program is
designed to stimulate community outreach, training, and education
efforts that will become the catalyst for reducing exposure to
environmental pollutants in underserved populations.  The main
objective of this RFA is to establish a new paradigm for linking
members of a community who are directly affected by adverse
environmental conditions with researchers and health care providers.
This will ensure that:

o  the community is aware of basic environmental health concepts,
issues, and resources;

o  the community has a role in identifying and defining problems and
risks related to environmental exposures;

o  the community is included in the dialogue shaping potential future
research approaches to the problem; and

o  the community actively participates with researchers and health
care providers in developing responses and setting priorities for
intervention strategies.

The aim of this program is to facilitate the process of developing
the trust needed for establishment of effective partnerships among
individuals who are adversely impacted by an environmental hazard in
a socioeconomically disadvantaged community, researchers in
environmental health, and health care providers.


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,
"Environmental Equity:  Partnerships for Communication," is related
to the priority area of Environmental Health.  Potential applicants
may obtain a copy of "Healthy People 2000" (Full Report:  Stock No.
017-001- 00474-0) or "Healthy People 2000" (Summary Report:  Stock
No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington DC  20402-9325 (telephone


Applications may be submitted by domestic for-profit and nonprofit
organizations, both public and private including predominantly
minority institutions, individually or as joint efforts of minority
institutions and majority institutions. Usually, only one award under
this RFA will be funded at an institution.  While a single
institution must be the applicant, a multi-institutional arrangement
(consortium) is possible.  Such consortia, entailing active
participation by more than one organization, are encouraged if there
is clear evidence of close interaction among the participants.

It is important to note that, because of the wide range of
environmental health problems to be addressed and the diversity of
affected communities, applications should include at least one of
each of the following:

o  A research scientist in environmental health sciences (such as
those at NIEHS Environmental Health Sciences Centers).

o  A primary health care provider directly involved in a community
affected by an environmental pollutant.  This individual could, but
need not necessarily, be affiliated with a county or state public
health department.

o  A member of an organization representing an underserved community
affected by an environmental pollutant.

The NIEHS has a significant commitment to the support of programs
designed to increase the number of underrepresented minority and
female scientists participating in biomedical and behavioral
research.  Therefore, applications from minority individuals and
women are encouraged.


This RFA will use the National Institutes of Health (NIH) Education
Grant (R25).  Responsibility for the planning, direction, and
execution of the proposed project will be solely that of the
applicant.  The total project period for applications submitted in
response to the present RFA may not exceed four years, and projects
are not renewable.

This RFA is a onetime solicitation for applications for new awards.
Future unsolicited competing continuation applications will compete
with all investigator-initiated applications and be reviewed
according to the customary peer review procedures.


The estimated total funds available for the first year of support for
the entire program are anticipated to be $500,000.  The maximum award
will be $150,000 in direct costs per year.  It is anticipated that
one to three grants will be awarded depending upon the availability
of funds for this purpose and the quality of the applications


The Extent of the Problem

Americans want to live long and healthy lives, and the majority of
them achieve that goal.  In general, however, people who are
economically disadvantaged and/or who live or work in areas and
occupations where conditions impart greater exposure to hazardous
substances are less likely to do so.  At every stage of life, these
persons suffer disproportionate levels of morbidity and mortality.
Evidence suggests that certain groups, especially minorities and
low-income communities, bear an uneven share of hazardous
environmental exposures.  Socioeconomically disadvantaged people
suffer the lowest life expectancy and highest adverse health
consequences of inadequate access to high-quality health care.
Additionally, they most often experience the highest degree of
exposure to environmental agents and frequently have the least
information available about the health consequences of exposure to
these agents.

Environmental equity refers to the perceived unequal burden of
residential exposure to greater than acceptable levels of
environmental pollution, occupational exposure to hazardous
substances, and fewer civic benefits such as sewage and water
treatment borne by socioeconomically disadvantaged persons.
Geographic location plays an important role in environmental exposure
of socioeconomically disadvantaged persons.  Inner city poor often
live in homes with high lead levels.  They may also be exposed to
higher levels of air pollution.  Toxic wastes sites are more frequent
in rural, low socioeconomic counties in the US.  Nuclear facilities
and chemical plants are often located in rural areas.  Exposure to
pesticides is another example where rural, socioeconomically
disadvantaged populations are at a greater than average risk.
Disadvantaged neighborhoods may rely on well water, which may be
polluted with toxic chemicals.  In addition, medical care is often
inadequate or unavailable to a significant proportion of the
socioeconomically disadvantaged and minority people in
America today.

Lead poisoning and the cognitive and developmental damage associated
with exposure to lead occur disproportionately among minorities.
High blood pressure and prostate cancer are very common among
African-Americans.  Low birth weight babies and other problems during
pregnancy are common among groups of women who do not have access to
good prenatal care.  Some of these conditions or other diseases may
have an environmental component in their etiology.  The lack of
resources for early identification of the effects of toxic agents may
lead to an increased disease burden in people who are economically
least able to cope with it.

Recent progress and opportunities

Some work has been done to investigate the effects of pesticides in
agricultural workers, of polychlorinated biphenyls in children in
rural areas, and of lead exposure in socioeconomically disadvantaged
urban children.  The effect of low versus high air pollutant exposure
on pulmonary function has been extensively studied.  Evidence from
the NHANES study has shown that, for comparable levels of exposure,
different racial groups have different levels of blood lead.  Some
evidence is also available that suggests the toxic effects of some
agents such as lead can be mitigated by good nutrition.

Many of these studies have used underserved populations, but none
have focused on such problems from the perspective of identifying
issues of highest impact on these populations. Thus, progress has
been minimal in most areas due to the lack of well-developed studies
targeting socioeconomically disadvantaged populations.  More effort
must be put into defining disadvantaged populations having high
levels of exposure to various types of environmental hazards in
residential or occupational settings.  Comprehensive outcomes to
these exposures must be defined and measured.  Prevention and
treatment of these effects must also be generated.

Prominent among the goals of the NIEHS is support of research aimed
at achieving environmental equity for all populations. It is equally
important to bring minority populations into the mainstream of
biomedical research as scientists, health care providers, and allied
health service professionals.  Both of these goals have a clear
benefit to the health of the nation and provide a means of addressing
a potential labor shortage in the twenty-first century.  As one new
aspect of this effort, the NIEHS is requesting submission of
applications that focus on establishing new avenues of communication
among those living or working in a community impacted by an
environmentally-related health problem and the researchers and health
care providers attempting to ameliorate such problems.

Objectives and Scope

The main objective of this program is to establish a new paradigm
linking members of the community, who are directly affected by
adverse environmental conditions, with researchers and health care
providers.  Development of community-based strategies to address
environmental health problems requires approaches that are not
typically familiar to the research and medical communities.
Customary approaches to risk assessment and management often neglect
the sociocultural context of environmental hazards.  The distinctive
needs of individual communities and their inhabitants are only rarely
considered in identifying environmental health problems and devising
appropriate medical intervention tactics.  Underserved populations
are often diverse, fragmented, and isolated, making it difficult to
obtain their input and to integrate their concerns in decision-making
processes.  Assays of the health effects of environmental pollution,
as well as regulations based on such assays, are often performed with
little or no input from the affected community.  The purpose of this
program is to institute mechanisms to bridge this communication gap.

Applicants are therefore expected to create partnerships between
researchers in environmental health, health care providers, and
representatives of low-income or minority communities affected by
environmental health problems.

Types of activities that may be proposed include, but are not limited

o  Develop efficacious methods for risk communication in minority and
low-income communities unfavorably impacted by environmental hazards.

o  Develop community-based, culturally sensitive educational programs
to mitigate adverse health effects from environmental toxicants in
minority and low-income communities.

o  Carry out community-based training to increase environmental
health literacy, i.e., increase awareness of the public, in such

o  Train and educate neighborhood health care professionals in the
diagnosis and treatment of disorders having an etiology related to
exposure to hazardous substances, i.e., increase awareness of health
care providers.  These providers should have a direct role in
assisting a community affected by exposure to an environmental

NIEHS wishes to encourage a broad, comprehensive approach to this
problem.  Applicants are encouraged to consider proposing some
combination of the above activities.

The following factors should be included in applications submitted in
response to this RFA:

o    A means of establishing effective input from an underserved
community affected by an environmental toxicant.  For example,
applicants may consider creating a community-based advisory board or
steering committee to facilitate outreach efforts.  This input could
be obtained directly from members of a community affected by an
environmental toxicant as well as from representatives of such groups
as community and neighborhood associations, churches, public housing
resident councils, community health centers, local public health
service departments, and minority educational institutions.

o   An objective assessment process designed to identify priority
areas in environmental health as perceived by community members, to
develop a consensus among community members as to plausible
approaches, and to detect any potential constraints in implementing
the project.

o   Development of a plan for the most effective means of reaching
the target audience.  For example, many socioeconomically
disadvantaged persons tend not to obtain information from the written
word.  Low- or no- literacy, as well as bilingual, materials may need
to be generated.

o   Development of appropriate education/communication modules.
Proposed projects should provide for dissemination of relevant
information within the community as well as a voice that reaches
researchers and health care providers.  There should be an effective
flow of information among all participants.

o   Feedback and evaluation of the project's effectiveness.  A
procedure should be established to assess the usefulness of the
project's education/communication activities.

o   Recommendations for future activities, beyond the period of NIEHS
funding, to assure continued participation of community members in
research and service programs addressing environmental inequities.

It is important to note that award of a grant under this RFA by the
NIEHS does not imply a commitment to future funding of any programs
planned with the support of such a grant.  Separate applications must
be submitted for such programs and such applications will be
evaluated on the basis of their own merits.


To encourage applicants to share information gained via these
projects, directors of these grants will be asked to attend an annual
meeting at NIEHS.



NIH policy is that applicants for NIH clinical research grants and
cooperative agreements will be required to include minorities and
women in study populations so that research findings can be of
benefit to all persons at risk of the disease, disorder or condition
under study; special emphasis should be placed on the need for
inclusion of minorities and women in studies of diseases, disorders
and conditions which disproportionately affect them.  This policy in
intended to apply to males and females of all ages.  If women or
minorities are excluded or inadequately represented in clinical
research, particularly in proposed population-based studies, a clear
compelling rationale should be provided.

The composition of the proposed study population must be described in
terms of gender and racial/ethnic group.  In addition, gender and
racial/ethnic issues should be addressed in developing a research
design and sample size appropriate for the scientific objectives of
the study.  This information should be included in the form PHS 398
in Sections 1-4 of the Research Plan and summarized in Section 5,
Human Subjects.

Applicants are urged to assess carefully the feasibility of including
the broadest possible representation of minority groups.  However,
NIH recognizes that it may not be feasible or appropriate in all
research projects to include representation of the full array of
United States racial/ethnic minority populations (i.e., Native
Americans (including American Indians or Alaskan Natives),
Asian/Pacific Islanders, Blacks, Hispanics).

The rationale for studies on single minority population groups should
be provided.  For the purpose of this policy, clinical research
includes human biomedical and behavioral studies of etiology,
epidemiology, prevention (and preventive strategies), diagnosis, or
treatment of diseases, disorders or conditions, including but not
limited to clinical trials.

The usual NIH policies concerning research on human subjects also
apply.  Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.  However,
every effort should be made to include human tissues from women and
racial/ethnic minorities when it is important to apply the results of
the study broadly, and this should be addressed by applicants.

If the required information is not contained within the application,
it will be returned to the applicant.

Peer reviewers will address specifically whether the research plan in
the application conforms to these policies.  If the representation of
women or minorities in a study design is inadequate to answer the
scientific question(s) addressed AND the justification for the
selected study population is inadequate, it will be considered a
scientific weakness or deficiency in the study design and will be
reflected in assigning the priority score to the application.

All applications for clinical research submitted to NIH are required
to address these policies.  NIH funding components will not award
grants or cooperative agreements that do not comply with these


Prospective applicants are asked to submit, by March 1, 1994, a
letter of intent that includes a descriptive title of the proposed
project, 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.  The letter of intent
influences neither review nor funding decisions, but it is helpful to
NIEHS staff in planning the review process, e.g., in estimating
workload and
avoiding conflict of interest.

Letters of intent should be directed to:

Ethel B. Jackson, D.D.S.
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD 17-09
Research Triangle Park, NC  27709


Applicants are to use Standard Form PHS 398 (rev. 9/91), which is
available from most institutional offices of sponsored research and
the Office of Grants Information, Division of Research Grants,
National Institutes of Health Westwood Building, Room 449, Bethesda,
MD  20892, telephone 301/496-7441.

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.

In order to assure proper identification of the application,
item 2a of the application form should be filled in as
follows:  Check the box indicated as "yes," enter the RFA
number as ES-94-05 and the title as "Environmental Equity:
Partnerships for Communication."  Each application should be
presented in the format used for an NIH research grant.

Mail the complete original application and three copies to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892
(Courier Services Zip Code 20816)

To expedite review, two copies should also be sent to:

Ethel Jackson, D.D.S.
Division of Extramural Research & Training
National Institute of Environmental Health Sciences
P.O. Box 12233
Research Triangle Park, NC  27709

All human and animal welfare as well as misconduct assurances must be
complete for a application to be reviewed.  All follow-up assurances
and approvals submitted as pending must be received within 60 days of
the application receipt deadline as the application will not be

The following is the schedule planned for this initiative.  It should
be noted that this schedule may be changed without notification due
to factors that were unanticipated at the time of the announcement.
Please contact the program official listed below regarding any
changes in the schedule.

Receipt of Letters of Intent  March 1, 1994
Application Receipt Deadline  April 1, 1994
Initial Scientific Review     June/July 1994
Advisory Council Review       September 1994
Funding                       September 30, 1994


Review will be carried out by the Scientific Review Branch, Division
of Extramural Research and Training.  Applications will be screened
by staff for responsiveness to the RFA.  Those considered
unresponsive will be returned to the applicant without review.
Responsive applications will be reviewed by either the Environmental
Health Sciences Review Committee or a special review committee
impaneled by the Scientific Review Branch.

If a greater number of applications are received than anticipated,
NIEHS will triage the applications.  Those applications identified as
the most competitive will be given a full scientific review and a
complete and detailed summary statement will be prepared.  The other
applications will be administratively withdrawn from competition and
the applicant and institutional official so notified.  The second
level of review will be provided by the National Advisory
Environmental Health Sciences Council.

The major review factors listed below will be used in evaluation of
applications for this RFA:

o  Scientific, technical, and/or medical significance and merit of
the proposed project as determined by such factors as its content,
originality, and feasibility.

o  Evidence of access to interaction with, input from a minority or
low-income, or underserved community, whose members' health is
adversely impacted by an environmental toxicant.  There should also
be evidence of effective involvement of such a community in
development of the application.

o  Capacity of the project to:

Identify key environmental hazards that affect the health and quality
of life of people who live in or around communities thought to be at

Establish a focus for information exchange related to environmental
health problems in socioeconomically disadvantaged communities.

Enhance awareness of environmental health problems among members of
the public and/or health care providers living or working in minority
or low-income communities.

Have a direct impact on the health or quality of life of individuals
in affected communities, e.g., by diminishing exposure to
environmental toxicants.

o  Appropriateness and adequacy of the approach and methodology
proposed to accomplish the project's objectives.

o  Qualifications and experience of the principal investigator and
staff, particularly but not exclusively in areas relevant to the
mission of NIEHS.  Personnel should demonstrate knowledge of the
needs of their target audience.  Applications must include, at a
minimum, a researcher in environmental health sciences, a health care
provider, and a member of an organization representing an underserved
community affected by an environmental pollutant.  There should be
evidence of effective cooperation and interaction among these staff
members in development of the application as well as in execution of
the project.

o  Structure and function of the community-based advisory board or
steering committee.  This group should facilitate information
exchange and achievement of the project's objectives.  There should
also be evidence of effective involvement of the advisory board in
development of the application.

o  Strength of institutional commitment as evidenced by provision of
appropriate resources, services, technical support, and allocation of

o  Availability of resources necessary to carry out the project.

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

o  Plans for evaluation of factors contributing to the project's
effectiveness.  Evaluations should include a measure of the impact of
the project on community members' knowledge and awareness of issues
and resources related to environmental health sciences.


The following will be considered in making funding decisions:

o  Quality of the proposed applications as determined by peer review.

o  Responsiveness to the goals of this RFA and the mission of the

o  Availability of funds.  Although this program is provided for in
the financial plans of the NIEHS, awards pursuant to this RFA are
contingent upon the availability of funds for this purpose.  Funding
beyond the first and subsequent years of the award will be
contingent upon satisfactory progress during the preceding year and
upon availability of funds.


NIEHS staff welcome the opportunity to clarify any issues or
questions from potential applicants.  Written or telephone inquiries
concerning the objectives, scope, and application procedures for this
RFA or inquiries about whether specific proposals would be responsive
are encouraged and should be directed to:

Donald McRee, Ph.D.
Environmental Health Resources Branch
National Institute of Environmental Health Sciences
P.O. Box 12233
Research Triangle Park, NC  27709
Telephone:  (919) 541-7634

Questions of an administrative or fiscal nature not directly related
to the programmatic aspects of this RFA should be directed to the
Grants Management Branch official listed below:

Mr. David Mineo
Grants Management Branch
National Institute of Environmental Health Sciences
P.O. Box 12233
Research Triangle Park, NC  27709
Telephone:  (919) 541-7628


This program is described in the Catalog of Federal Domestic
Assistance Number 93.113, 93.114 and 93.115.  Awards are made under
authorization of the Public Health Service Act, Title IV, Part A
(Public Law 100-607) and administered under PHS grant policies and
Federal Regulations 42 CFR Part 52 and 45 CFR Part 74.  The program
is not subject to the intergovernmental review requirements of
Executive Order 12372 or Health Systems Agency review.


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