Full Text HD-94-008

HISPANIC CHILD HEALTH:  SOCIAL, BEHAVIORAL, AND CULTURAL FACTORS

NIH GUIDE, Volume 22, Number 31, August 27, 1993

RFA:  HD-94-008

P.T. 34, FD

Keywords: 
  Behavioral/Social Studies/Service 
  Sociology 
  Demography 
  Migration 


National Institute of Child Health and Human Development

Application Receipt Date:  January 7, 1994

PURPOSE

The Demographic and Behavioral Sciences Branch (DBS) of the Center
for Population Research, National Institute of Child Health and Human
Development (NICHD) is inviting grant applications for the support of
research on social, demographic, behavioral, and cultural factors in
Hispanic child health.

The purpose of the Request for Applications (RFA) is to encourage
theoretically and methodologically innovative research to address
scientific issues among the Hispanic population and to better address
the needs of its children.  Issues of interest are (a) factors that
promote low rates of infant mortality and chronic disease in some
Hispanic subgroups, despite the experience of racism and poverty by
this population; (b) how the experience of migration, its antecedents
and consequences, affects the health of Hispanic subgroups and their
children; (c) how trends in fertility and mortality may change over
time and space in response to changing characteristics of the
population; and (d) factors that have led to different health
outcomes among different Hispanic subpopulations, and to differences
in the social, demographic, behavioral, and biological predictors of
those outcomes.

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.  The RFA,
Hispanic Child Health:  Sociodemographic, Behavioral and Cultural
Factors, is encouraging research that has implications for the
objectives targeting Hispanics.  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.
017-001-004734-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic for-profit and non-profit
organizations, public and private, such as universities, colleges,
hospitals, laboratories, units of States or local government and
eligible agencies of the Federal government.  Applications from
minority individuals and women are encouraged.  Domestic applications
may include an international component.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) individual
research grant (R01) and the FIRST (R29) awards.  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
five years.  This announcement is for a single competition with the
application receipt deadline of January 7, 1994.  The anticipated
award date is  August 1, 1994.

Because the nature and scope of the research proposed in response to
this RFA may vary, it is anticipated that the size of an award will
vary also.

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

FUNDS AVAILABLE

$900,000 in direct costs are set aside for the first year of support.
It is anticipated that six grants will be made from NICHD funds.

It is anticipated that only new applications will be received.  The
level of support is dependent on the receipt of a sufficient number
of applications of high scientific merit.  Although this program is
provided for in the financial plans of the NICHD, awards pursuant to
this RFA are contingent upon the availability of funds for this
purpose.

RESEARCH OBJECTIVES

Background

This RFA is a response to a request the U.S. Congress addressed to
the NICHD.  In Report No. 102-708, the House of Representatives
Committee on Appropriations expressed concern about the health of
Hispanic children in the United States.  The Committee urged NICHD to
increase research in this area.  The report language stated the
rationale for this research effort as follows:  "Hispanics differ
from other groups in rates of infant mortality, adolescent pregnancy,
risk-taking behavior, chronic childhood illness, and childhood
obesity.  The high rates of poverty experienced by many Hispanic
mothers and children may contribute to these problems.  The duration
of time living in the U.S. also appears to be a problem related to
the incidence of poor health."

This RFA also responds to the report, "One Voice, One Vision --
Recommendations to the Surgeon General to Improve Hispanic Health."
The Research Agenda of the Surgeon General's National Hispanic/Latino
Health Initiative identified the need for culturally appropriate
theoretical frameworks and research methodologies to address the
unique research needs of the diverse Hispanic/Latino population
groups.  Copies of the report may be obtained from the Office of the
Surgeon General, Department of Health and Human Services, 200
Independence Avenue, SW, Washington, DC 20201 (telephone
202-690-7163).

This RFA is also partially an outgrowth of a 1987 initiative by the
NICHD, titled "Social and Demographic Research on Infant Mortality
and Low Birthweight."   Research conducted under that RFA has
addressed some of the demographic, social, and behavioral issues
related to the health of Hispanic, particularly Mexican-American,
women and children.

Other

The purpose of this RFA is to address the sociodemographic,
behavioral, and cultural factors that affect child health among
Hispanic subpopulations in the United States.  Individuals of Central
or South American, Cuban, Mexican, Puerto Rican, or some other
Spanish origin are considered to be Hispanic, regardless of race.
Variations within subgroups may be as important as variations among
them.  Contrasts may also be drawn between U.S. groups and those in
the countries of origin if they shed light on the experience of U.S.
populations.

Child health refers to characteristics of children ages 0-17 that can
affect the likelihood of attaining full growth, optimal development
and well-being.  In so far as reproductive or family health and
behavior, including fertility or maternal or paternal behavior, may
affect child health, it is within the scope of this RFA.  The intent
of the RFA is to direct attention to the social, behavioral, and
cultural factors that affect child health rather than to pathological
or clinical conditions, per se.

The Hispanic population in the U.S. is characterized by a relatively
young age structure, high fertility, and a diversity of culture,
economic well-being, and educational and labor market experience.
While the experiences of some subgroups, such as the Hispanics of New
Mexico, are deeply rooted, others have experienced rapid change.  The
majority of U.S. Hispanics have long been concentrated in the
Southwestern states, but the composition of this population has
changed in recent years with a new influx of immigrants from Central
America as well as from Mexico.  Other major Hispanic communities, in
South Florida, and in the Northeastern states, have also altered in
composition with the addition of new immigrants.  Rapid population
growth in some areas has strained social, health, and educational
resources.  While the majority of Hispanics in the U.S. are urban,
background factors for child health may operate differently for rural
or migrant populations.  Populations who live along the U.S.-Mexico
border experience a unique constellation of economic, legal,
ecologic, and cultural factors which can affect child health.
Proximity to the border may affect a range of choices (e.g., health
care, jobs, family responsibilities) that individuals make, as well
as the structural factors that condition those choices.

In addition to geographic variation, there is evidence that the
culture, behavior, demographic and health characteristics of Hispanic
origin populations change with duration of residence in the United
States.  It has been suggested that the health conditions of some
immigrants may worsen over time as they adopt the behaviors of people
born in the United States.  There is also evidence that the fertility
of Hispanic women changes by generation in the U.S.  Some changes and
adaptations to United States culture and norms may be beneficial
(increased positive valuation of education for women), but
countervailing changes may worsen health outcomes (e.g., increase in
substance use).  Research is needed that describes how and why
duration of residence in the U.S. is related to health outcomes.

Until fairly recently, the unique historical, migratory, and cultural
experience of each Hispanic subpopulation has been ignored, but
recognition of these is a central focus of this RFA.  An important
way to advance our understanding of the health of the Hispanic
population is to move away from using ethnicity as a simple
identifier to a multi-dimensional characterization.  Improvements in
conceptualizations of ethnic identity, as they affect health
outcomes, are called for.

To achieve a deeper understanding of Hispanic subpopulation
characteristics and how they affect child health, a range of methods
may be used, either singly or in combination.  These can be
demographic, econometric, or epidemiological, and/or they may be
triangulated with ethnographic methods or historical or archival
data.  The use of ethnographic methods may be particularly
appropriate for an improved understanding of the cultural factors
that contribute to Hispanic child health.  Interdisciplinary research
is encouraged.

Additional examples of relevant research topics include, but are not
limited to:

o  Household and kinship structures among Hispanics have long
interested U.S. sociologists and epidemiologists because of the
presumed positive effect of these structures on health and mortality.
Recent evidence suggests that extended households may be formed by
need as well as preference.  Additional research is needed to
determine to what extent these structures represent economic or
cultural choices, and how they are affected by changes in age
structures, labor markets, and internal and external migration.  How
do different types of household and kin structures affect child
health?

o  Some, but not all, U.S. Hispanics are involved in cyclical
migration, for example between Puerto Rico and the mainland, or
between Mexico and the U.S.  Other Hispanics are involved in internal
migration, as agricultural laborers or as labor markets form and
reform.  How do these different types of migration affect health,
particularly children's health, either indirectly through parental
health and demographic behavior, or directly?  How does access to
education and health services modify the effects of migration on
health?

o  Many researchers have identified the paradox that, despite their
relative poverty and lower educational attainment, infants born to
mothers of Mexican descent have low birth weight and infant mortality
rates that are similar to those of non-Hispanic whites.  These rates
increase for Mexican-origin mothers born in the U.S.  This pattern
parallels that for chronic disease mortality, and may be related to
transcultural changes in maternal nutrition and/or substance use.
Insightful research is needed to explore the separate and joint
effects of socioeconomic, behavioral, cultural, and biological
factors on the perinatal and infant outcomes of Hispanic infants.

o  Patterns of residential segregation in the U.S. by race and
ethnicity have been well documented.  At the same time, a new array
of conceptual and methodological tools are encouraging researchers to
address other contextual influences on demographic behavior and
health.  Family structure and health practices may mediate these
contextual influences on children's health and well-being, or they
may have direct effects.  Contextual influences may be
sociodemographic, such as percentage of households in poverty, or
degree of residential segregation; they may be behavioral, such as
proportion who attend church regularly; they may be cultural, such as
shared understanding of gender roles, or valuation of parenthood.
Research is needed that addresses these relationships for U.S.
Hispanics, and takes into account some of the unique characteristics
of Hispanic subgroups and their neighborhoods.

o  Among Hispanic adolescents there is an excess of behaviorally
related morbidity and mortality, including sexually transmitted
disease, and injuries and deaths due to violence and accidents.
Since 1988 there has been a large percentage increase in births to
Hispanic females ages 15-19; early childbearing carries a somewhat
greater medical risk for the infant, and limits the educational,
marital, and occupational opportunities of the young parents.
Research is needed on the cultural and behavioral antecedents of
these outcomes.  How do concepts of gender-appropriate roles and
behaviors influence the choices and constraints experienced by
Hispanic adolescents?  To what extent are they influenced by family
structure and relationships, or by features of the adolescent's
community?

o  Many Hispanics enter the U.S. with lower levels of education than
other immigrants.  Once in the United States, Hispanics are less
likely to graduate from secondary school or college than
African-Americans or non-Hispanic whites.  Research is needed to
clarify the role of schooling, particularly in relation to adolescent
health.  What are the factors affecting transitions from school to
work to family formation among Hispanics?   Are there other life
course orderings or transitions that are normative for Hispanics, and
how do these affect health?  Are there specific aspects of schooling,
such as language barriers, that facilitate or impede the health of
Hispanic children?

o  Family centeredness or "familism" is often identified as a
health-protective factor among Hispanics.  Research is needed to
identify the factors that facilitate or constrain familism.  These
could range from policies (governmental supports and programs) to
regional or local geopolitical or economic conditions, or
neighborhood features, as well as the structures and characteristics
of families themselves.  In these contexts, how do men and women
balance family roles and make choices about the use of time and other
resources?  In turn, how do these factors affect child health?

One of the major issues in conducting research on Hispanic
subpopulations is the problem of sample size.  While there may be
sufficient numbers of Mexican- or Puerto Rican-Americans in some data
sets, there may be insufficient numbers of Central Americans or
Cubans.  The following data sets have been supported by the NICHD and
contain Hispanic samples of varying sizes:  the National Longitudinal
Survey of Youth, the 1988 National Maternal and Infant Health Survey,
the National Survey of Families and Households, the National Survey
of Family Growth, and the Hispanic Health and Nutrition Survey.
Other possible data sets are the 1988 Puerto Rico Fertility and
Family Planning Assessment, the 1985-86 New York Fertility,
Employment, and Migration Survey, the National Educational
Longitudinal Survey, or Bureau of the Census data sets such as the
Survey of Income and Program Participation and the Current Population
Survey.  Respondents to this RFA may want to consider use of one or
more of these data sets alone or in combination with other forms of
data collection.  They may propose collecting their own data,
performing secondary analysis of other data sets, or using
ethnographic data.

SPECIAL REQUIREMENTS

Annual meetings will be held to foster the sharing of information,
data, and other research experiences.  Principal Investigators are
encouraged to attend these meetings, and funds must be included in
the application budget for one two-day meeting per year in Bethesda,
Maryland to discuss the research with other investigators.  A
statement about the willingness to engage in annual meetings should
be included with the application.

STUDY POPULATIONS

Research should focus primarily on U.S. populations although non-U.S.
populations may be used to the extent that they increase our
understanding of U.S. Hispanics.  The ultimate objective of this RFA
is to improve our understanding of child health in the U.S. Children
are considered to be age 17 years and under; thus young and middle
adolescents are included.  The study population may be adults since
many of the research issues pertinent to child health and well-being
require an understanding of the adult population.  Non-Hispanics may
be included for comparative purposes.

STUDY POPULATIONS

SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH
POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL
RESEARCH STUDY POPULATIONS

For projects involving clinical research, NIH requires applicants to
give special attention to the inclusion of women and minorities in
study populations.  The focus of this RFA is one U.S. minority group,
Hispanic-Americans.  Other minorities may be included for comparison
purposes but should not be the focus of the application.  If women
are not included in the study population, a specific justification
for the exclusion must be provided.  Applications without such
documentation will not be accepted for review.

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 must be addressed in developing a research
design and sample size appropriate for the scientific objectives of
the study.  This information must be included in the form PHS 398
(rev. 9/91) in Sections 1-4 of the Research Plan AND summarized in
Section 5, Human Subjects.

For the purpose of this policy, clinical research is defined as 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.

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

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 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
policies.

APPLICATION PROCEDURES

Applications are to be submitted on form PHS 398 (rev. 9/91) that is
available in most institutional offices of sponsored research and
from the Office of Grants Information, Division of Research Grants,
National Institutes of Health, Westwood Building, Room 449 Bethesda
MD 20892, telephone (301) 594-7250.  FIRST (R29) award applications
must include at least three sealed letters of reference attached to
the face page of the original application.  FIRST (R29) award
applications submitted without the required number of reference
letters will be considered incomplete and will be returned without
review.  Applications must be identified by checking the "YES" box in
Item 2a on the face page of the application and by typing the words,
"In Response to RFA HD-94-008."

The RFA label in form PHS 398 must be affixed to the bottom of the
face page of the original 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.  The signed
typewritten original (topmost), including the Checklist, and three
signed copies of the applications must be sent or delivered in one
package to:

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

It is extremely important for the timely review of your application
that two additional be sent under separate cover to:

Susan Streufert, Ph.D.
Division of Scientific Review
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 5E03
Bethesda, MD  20892
Telephone:  (301) 496-1485

Applications must be received by January 7, 1994.  Late applications
will not be accepted.  If an application is received after that date,
it will be returned to the applicant without review.

Review Considerations

Upon receipt, applications will be reviewed by NICHD staff for
completeness and responsiveness to the RFA.  Incomplete applications
will be returned to the applicant without further consideration.  If
the application is judged to be non-responsive to the RFA, NIH staff
will return the application to the applicant.  The applicant may
resubmit the application and have it assigned for review in the same
manner as unsolicited grant applications during the next review
cycle.

If the application submitted in response to this RFA is substantially
similar to a grant application already submitted to the NIH for
review, but has not yet been reviewed, the applicant will be asked to
withdraw either the pending application or the new one.  Simultaneous
submission of identical applications will not be allowed, nor will
essentially identical applications be reviewed by different review
committees.  Therefore, an application cannot be submitted in
response to this RFA that is essentially identical to one that has
already been 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.

Applications may be triaged by an NICHD peer review group on the
basis of relative competitiveness.  The NIH will withdraw from
further competition those applications judged to be non-competitive
for award and notify the applicant Principal Investigator and
institutional official.  Those applications judged to be competitive
will undergo further scientific merit review by a special study
section convened by NICHD in accordance with the criteria stated
below.  The second level of review will be provided by the NICHD
National Advisory Council.

The review criteria for the research projects are generally the same
as those for unsolicited research grant applications:

o  scientific and technical significance of proposed research;

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

o  qualifications and research experience of the Principal
Investigator and staff, particularly, but not exclusively, in the
area of the proposed research;

o  availability of resources necessary to perform the research;

o  appropriateness of the proposed budget and duration in relation to
the proposed research.

In addition, applications will be judged on the significance and
appropriateness of the research problem and methods to the Hispanic
population of the U.S.

AWARD CRITERIA

The anticipated date of award is August 1, 1994.

Responsiveness to the RFA, scientific merit, and technical
proficiency, as described in the application, will be the predominant
criteria for determining funding.  An attempt will be made to ensure
that different Hispanic sub-groups and a diversity of subject matter
will be represented in the applications receiving awards.

INQUIRIES

Written and telephone inquiries are encouraged.  The opportunity to
clarify any issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Nancy E. Moss, Ph.D.
Center for Population Research
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8B13
Bethesda, MD  20892
Telephone:  (301) 496-1174

Direct Inquiries regarding fiscal matters to:

Melinda B. Nelson
Office of Grants and Contracts
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17
Bethesda, MD  20892
Telephone:  (301) 496-5481

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance No. 93.864 and No. 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 PHS grants policies and Federal
Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not
subject to the intergovernmental review requirements of Executive
Order 12372 or Health Systems Agency review.

.

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