Expired NOT-CA-21-071: Notice of Special Interest (NOSI): Expanding Cancer Control Research in Persistent Poverty Areas

Notice of Special Interest (NOSI): Expanding Cancer Control Research in Persistent Poverty Areas

Notice Number:

NOT-CA-21-071

Key Dates

Release Date:

April 27, 2021

First Available Due Date:

September 24, 2021

Expiration Date:

May 08, 2023

Related Announcements

PAR-20-077 - National Cancer Institute Program Project Applications (P01 Clinical Trial Optional)

Issued by

National Cancer Institute (NCI)

Purpose

The purpose of this Notice is to inform potential applicants about the National Cancer Institute (NCI)’s special interest in providing resources to support highly collaborative, multi-disciplinary Program Projects (P01s) that focus on the development and conduct of cancer control research in low-income and/or underserved populations living in persistent poverty (PP) areas. NCI is interested in programs that address the challenges and opportunities related to working in partnership with local clinics and other health or public health-related organizations to enhance the prevention of cancer and delivery of cancer care strategies to reduce the burden of cancer in PP areas.

There are several areas where NCI can play a significant role in advancing cancer control research in PP areas and improve efforts to achieving health equity for all. This NOSI is a part of a larger NCI research initiative to inform, test, implement, and strengthen cancer control programs that are sustainable in PP areas across the United States (U.S.).

Background

Populations living in poverty in the U.S. in particular, those living in PP, face higher rates of cancer morbidity and mortality. The U.S. Department of Agriculture’s Economic Research Service has defined counties as being persistently poor if 20% or more of their populations were living in poverty based on 1980, 1990, and 2000 decennial censuses and the 2007-11 American Community Survey 5-year estimates. For a list of PP counties in the USA, click here. Using this definition, there are 353 PP counties in the U.S., comprising 11.2% of all U.S. counties. The large majority (301 or 85%) of the PP counties are nonmetropolitan, accounting for 15.2% of all nonmetropolitan counties in the U.S. Persistent poverty also demonstrates a strong regional pattern, with nearly 84% of PP counties located in the South, comprising more than 20% of all counties located in the region.

An important dimension of poverty, which is defined as having an income below a federally determined poverty threshold, 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 for a longer time period. Hence, individuals residing in PP areas are at an increased risk of cancer due to multilevel factors, including lower educational attainment and health literacy, greater exposure to carcinogenic environments, lack of adequate housing and transportation, food insecurity, and inadequate access to health care, among other challenges. Increased risk of cancer for those living in PP areas are also associated with increased cancer incidence and delayed cancer diagnosis, treatment, and subsequently, lower rates of survival.

Although PP by itself is detrimental to health, cancer-related disparities in PP communities may be further exacerbated by race/ethnicity. For example, Blacks living in rural areas in PP fare worse in terms of cancer outcomes compared to Blacks in urban areas. Understanding the intersectionality of PP and other factors, especially in racial and ethnic subgroups, is important to inform targeted prevention and intervention strategies.

Research Objectives

To advance cancer control research, the NCI will support a program of research that addresses cancer-related disparities in populations residing in PP areas of the U.S. Proposed scientific projects should include multilevel interventions that address underlying factors affecting poverty and examine other social determinants of health in one or more areas across the cancer control continuum, including prevention, diagnosis, treatment, survivorship, and end-of-life care research.

Persistent Poverty: The U.S. Department of Agriculture (USDA) Economic Research Services (ERS) has defined persistent poverty at the county level. According to ERS, counties are designated as being persistently poor if 20% or more of their populations were living in poverty based on 1980, 1990, and 2000 decennial censuses and 2007-11 American Community Survey 5-year estimates (https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/).

There are also smaller areas, such as census tracts, that experience persistent poverty which provides a broader representation (compared to county level), across all the states and Puerto Rico to include communities in extreme poverty. The U.S. Census defines census tracts as small, relatively permanent statistical subdivisions of a county or equivalent entity (https://www.census.gov/programs-surveys/geography/about/glossary.html#par_textimage_13). NCI, in working with ERS of the USDA, has defined persistent poverty at the census tract level. At the census tract, persistent poverty is wherein 20% or more of the population in a census tract is below the federal poverty line based on 1990 and 2000 decennial censuses and 2007-11 and 2015-2019 American Community Survey 5-year estimates. A list of the census tracts in persistent poverty is provided on the NCI Geographically Underserved Areas website.

All proposed research studies can choose to conduct research either at the census tract level (provided list of census tracts) or the county level. For a list of PP counties in the U.S., click here.

Please note, the USDA has a separate designation for Persistent Child Poverty counties, which is included in the ERS USDA Excel document linked above. The focus of this NOSI is on the 353 Persistent Poverty counties, however, if a project is focused on pediatric or childhood cancer (patients less than 18 years of age), the application may propose working in one of the designated Persistent Child Poverty counties.

This NOSI uses the P01 mechanism, and in addition to the criteria set out by NCI for P01 applications, projects/cores should include but are not limited to:

Partnerships and collaborations with community-affiliated clinics or hospitals; state offices of health; area health education centers; state health associations; primary care networks or associations; departments of health, education, or human services; and/or other community organizations in PP areas (defined above).
Engagement of clinic partners, community advisors, and other relevant stakeholders.
Proposed research working with subpopulations in specific areas and/or within racial/ethnic groups, which will allow for the inclusion of the social context and needs of the community.
Incorporation of geographical and spatial context and its correlates (e.g., proximity to different natural, built, economic and health features of places) into comparative, multilevel studies to help address heterogeneity amongst the counties suffering from PP.
At least one project focusing on the development and implementation of multilevel interventions with cancer prevention and control-related outcomes that also address the social context/needs of the populations living in PP areas.

NCI encourages programs to consider developing research projects that include, when relevant, some of the following research concepts and areas:

Support for members of a multidisciplinary team to build and maintain the program, including an identified lead staff member who will manage the program in these clinical care settings;
Inclusion of training of medical or non-medical personnel to build a cancer prevention and control research program.
Strongly encourage at least one project be located outside then NCI-designated cancer center’s catchment area.
Collaboration with safety net providers or critical care hospitals who may have limited research infrastructure or previous experience participating in cancer prevention and control research due to their focus on the delivery of primary care. Integration of social services into clinical settings would be within scope. Researchers are encouraged to work with these clinics to build, collaborate, and implement a cancer prevention and control research agenda.
Implementation and utilization of telehealth systems and capacity to support and sustain cancer control research programs, for example, in clinics (including primary care clinics).
Utilization of a systems-based approach, i.e., one that integrates with electronic health care record systems and can be generalizable to additional centers or other parts of their health care system; extend cancer control services to family members of cancer patients and/or other persons within their health care system; and include written commitment to the program from leadership at the cancer center, clinic, and/or hospital and/or health care system(s) level (if relevant).
Implementation of community-clinical linkages aimed at improving connections between community, public health, and clinical sectors to improve cancer prevention and control research in PP communities.
To achieve health equity and ensure quality cancer care, it is imperative for the research to focus on issues that will alleviate the structures and barriers that perpetuate inequities. Therefore, applications should develop interventions that are sustainable to address these inequities.

Non-responsive Applications

Applications with the following attributes will be deemed non-responsive and will not be reviewed:

Inter-race/ethnicity (e.g., Blacks versus Whites) or inter-geographical (rural-urban) comparisons will not be considered.
Programs that purely use a telehealth program without on-the-ground partnership development will not be considered as responsive to this initiative.

Application and Submission Information:

This notice applies to due dates on or after September 24, 2021, and subsequent receipt dates through May 8, 2023.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcements through the expiration date of this notice.

Activity Code	FOA Title	First Available Due Date
P01	National Cancer Institute Program Project Applications (P01 Clinical Trial Optional)	September 24, 2021

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

For funding consideration, applicants must include NOT-CA-21-071 (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.

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

Inquiries

Please direct all inquiries to the Scientific/Research, Peer Review, and Financial/Grants Management contacts in Section VII of the listed funding opportunity announcements.

Scientific/Research Contact(s)

Shobha Srinivasan, Ph.D.
Division of Cancer Control and Population Sciences
National Cancer Institute
Telephone: 240-276-6938
Email: sriniva2@mail.nih.gov