This notice informs the current National Cancer Institute (NCI) R01 awardees of NCI’s special interest in administrative supplement applications that seek to address cancer control research in “geographically underserved areas.” For the purposes of this notice, geographically underserved areas refers to (1) areas and populations with high and/or persistent poverty, or (2) areas and populations living with high and/or persistent poverty in Health Professional Shortage Areas (HPSAs) or Frontier and Remote (FAR) area zip codes (definition and FAR codes can be found at: https://www.ers.usda.gov/data-products/frontier-and-remote-area-codes).

This administrative supplement intends to provide funding for one year to NCI R01 grantees with an aim to further their current cancer control research study (in areas including but not limited to, social and behavioral sciences research, and healthcare delivery). The administrative supplement applications must focus on geographically underserved areas and populations to examine factors affecting cancer control outcomes. Applicants would be required to extend their study to these geographically underserved areas within the scope of their parent grant.

Background

Despite advances in cancer prevention, diagnosis, treatment and survival, disparities in cancer outcomes continue to persist with increased mortality among people living in poverty. Populations in poverty in particular high poverty and/or persistent poverty (definition and map of persistent poverty counties in the United States can be found at: https://www.ers.usda.gov/data-products/county-typology-codes/descriptions-and-maps/#ppov) are at an increased risk of cancer due to greater carcinogen exposure, low educational attainment, lack of adequate housing, challenges accessing food and food insecurity, and the lack of access to care. All these factors result in increased cancer incidence and delayed cancer diagnosis, treatment, and subsequently, lower rates of survival. In particular, people living in poverty have higher rates of cancers caused by occupational, recreational, or lifestyle exposures (e.g., colorectal, laryngeal, liver, lung) and by human papillomavirus infection (e.g., anal, cervical, oral). These issues are further exacerbated in areas lacking (or ineligible to qualify as HPSAs) health facilities designated by the Health Resources and Services Administration (HRSA) as HPSAs. However, these populations in the ‘geographically underserved areas’ have previously not been a significant component of cancer control research.

Specific Research Objectives

The NCI is proposing to fund supplements to current R01 grantees in a more targeted manner focusing on ‘geographically underserved areas’ to stimulate research in communities where people are living in high and/or persistent poverty. Additional consideration will be given to supplement applications focusing on populations in FAR areas and/or HPSAs with high and/or persistent poverty.

NCI encourages partnerships with Housing and Urban Development, Public Health departments, Rural Health Departments, tribal clinics and other departments/agencies to identify and target populations for cancer control research.

As such, awardees will be expected to address challenges and opportunities for cancer control and prevention strategies to improve overall health and lessen the burden of cancer in these areas. The long-term goal of this supplement is to extend cancer prevention and control research in geographically underserved areas (including but not limited to, implementing novel interventions in social, behavioral and health care delivery; dissemination and implementation of evidence-based programs and practices; etc.).

Key terms for this Notice of Special Interest

High Poverty: 'High poverty' is where at least 20 percent of the population have incomes below the Federal poverty threshold using 2018 poverty estimates. (https://www.census.gov/data-tools/demo/saipe/#/?map_geoSelector=aa_c&s_measures=aa_snc&s_year=2018)

Persistent Poverty: An important dimension of poverty is its persistence over time. An area that has a high level of poverty this year, but not next year, is likely better off than an area that has a high level of poverty in both years. To shed light on this aspect of poverty, the US Department of Agriculture’s Economic Research Service (ERS) has defined counties as being persistently poor if 20 percent or more of their populations were living in poverty based on the 1980, 1990, and 2000 decennial censuses and 2007-11 American Community Survey 5-year estimates. Using this definition, there are 353 persistently poor counties in the U.S. (comprising 11.2% of all U.S. counties). The large majority (301 or 85.3%) of the persistent-poverty counties are nonmetro, accounting for 15.2%of all nonmetro counties. Persistent poverty also demonstrates a strong regional pattern, with nearly 84%of persistent-poverty counties in the South, comprising more than 20%of all counties in the region (https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/).

Frontier and Remote Area (FAR): The FAR zip codes assist in providing policy-relevant information about conditions in sparsely settled, remote areas of the U.S. to public officials, researchers, and the general public. ERS has developed ZIP-code-level FAR codes. The aim is not to provide a single definition, but to meet the demand for a delineation that is both geographically detailed and adjustable with reasonable ranges, in order to be usefully applied in diverse research and policy contexts. This updated set of codes, based on urban-rural data from the 2010 decennial census, provides four FAR definition levels, ranging from one that is relatively inclusive (12.2 million FAR level one residents) to one that is more restrictive (2.3 million FAR level four residents; https://www.ers.usda.gov/data-products/frontier-and-remote-area-codes/). Note: For the purpose of this supplement, please use the FAR1 code.

Health Professional Shortage Areas (HPSAs): These are geographic areas, populations groups, or facilities (https://bhw.hrsa.gov/shortage-designation/types) within the U.S. that are experiencing a shortage of health care professionals. https://bhw.hrsa.gov/shortage-designation/what-is-shortage-designation.

Responsiveness

To be considered responsive, supplement applicants are required to review the following PDFs (https://cancercontrol.cancer.gov/research-emphasis/underserved.html) as developed by HRSA to identify ‘geographically underserved areas’ for research. The first file (https://cancercontrol.cancer.gov/pdf/Poverty-Areas.pdf) provides a list of counties that are in high and/or persistent poverty; notes whether they are in metro or nonmetro areas; and designates whether they are in HPSAs. The second PDF (https://cancercontrol.cancer.gov/pdf/FAR-Codes.pdf) identifies the FAR area zip codes and the counties in which they are located. We acknowledge that the data on high and persistent poverty is provided at two different time periods, which is unavoidable due to the lack of data availability.

1. Applicants should justify how their application addresses a population that is primarily living in high and/or persistent poverty counties or FAR zip codes.

2. Preference will be given to applicants examining rural/non-metro areas, HPSA and/or FAR areas where populations are in high and/or persistent poverty.

3. If appropriate, applicants should also clearly demonstrate collaboration with local stakeholders and allocate funds to support the work of proposed partners and stakeholders.

4. Appropriate activities for these supplements include, but are not limited to:

• Collection of preliminary data for research in social, behavioral and health care delivery; and/or
• Testing/Implementing intervention studies in cancer control (such as in social, behavioral and health care delivery; tobacco cessation; physical activity; access to care; etc.)

NOTE: These supplements are not for community outreach alone or only building awareness for cancer control programs.
Keeping to the requirement that administrative supplements must support work within the scope of the original project of the eligible parent award, interested and eligible awardees (as applicants) should be aware that only activities (i.e., augmented efforts) required for extending the areas of reach to ‘geographically underserved’ areas that are above and beyond the activities covered in the budget of the original grant are eligible for supplemental funding.

Investigators are encouraged to discuss their application with the scientific/research contact listed in this notice prior to submission.

Application and Submission Information

Applications for this initiative must be submitted using the following opportunity or its subsequent reissued equivalent.
PA-18-591 - Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and PA-18-591 must be followed, with the following additions:

Eligibility: To be eligible, the applicant’s parent award must be able to receive funds in the fiscal year 2020 (FY20) and be active throughout the 1-year project period of the administrative supplement. The parent award must not be in an extension period (e.g., no-cost extension).

Application Due Date: Submissions must be received by May 15, 2020 at 5:00 PM local time of applicant organization for FY 2020 funding. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

Budget: NCI will consider application budget requests of no more than $200,000 in total costs and must reflect the actual needs of the proposed project.

Eligible Individuals (Program Director/Principal Investigator): The awardee/applicant must hold an active R01 grant from the NCI.

Submitting Application:

• Applicants should begin their ‘Research Strategy’ by referencing this Notice's number (NOT-CA-20-035) in their submission.
• Page limit: The ‘Research Strategy’ is limited to 2 pages and summarize the activities of the parent grant that encompass those proposed in the supplemental request and describe how those activities are proposed for augmentation and/or enhancement in the supplemental request by describing:
  • The supplement's purpose in extending it to the ‘geographically underserved areas’;
  • The relationship of the supplement request to the parent grant;
  • How the application provides additional value to the underlying research (parent grant) of the PD(s)/PI(s) and the collaborating investigators; and
  • The activities to be covered by the supplemental funding, including 1) Collection of preliminary data for research in social, behavioral and health care delivery cancer control; and/or 2) Testing/Implementing intervention studies in cancer control (such as in social, behavioral and health care delivery; tobacco cessation; physical activity; access to care; etc.).
• In order to facilitate efficient processing correct routing of the request, applicants are strongly encouraged to notify Dr. Amy Kennedy (amy.kennedy@nih.gov), as well as the assigned NCI program officer for the parent award that a request has been submitted in response to this NOSI.

Evaluation Process:
NCI will conduct administrative reviews of applications and will support the most meritorious applications submitted for consideration, based upon the availability of funds.
NCI Program staff will evaluate applications using the following selection factors:

• The relevance of the proposed activities to the parent grant and original work scope;
• Satisfactory progress toward achieving the aims of the parent grant, as appropriate to the current stage of the project;
• Impact of the proposed work to advance the science;
• Appropriate and well-described plan to accomplish the goals within the timeframe proposed.

Applications nonresponsive to terms of this NOSI will be not be considered for the NOSI initiative.

Critical consideration:
1. Does the administrative supplement reasonably allow for the proposed project to be completed, given the time and budget requested?
2. Does the work in the administrative supplement fill an identified gap in the scientific literature

NOTE: For funding consideration, applicants must include “NOT-CA-20-035” (without quotation marks) in the Agency Routing Identifier field (box 4b) of the SF424 R&R form. Applications without this information in box 4b will not be considered for this initiative.