Request for Information (RFI) on Opportunities for Promoting Cardiovascular Health of Mothers and Children through Evidence-based Maternal, Infant, and Early Childhood Home Visiting Programs

Notice Number: NOT-HL-19-729

Key Dates
Release Date: November 20, 2019
Response Date: February 07, 2020

Related Announcements
None

Issued by
National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF)

Purpose

This Request for Information (RFI) is to solicit ideas on opportunities for promoting cardiovascular health of mothers and children through evidence-based maternal, infant, and early childhood home visiting programs.

Background

In 2016, NHLBI published its Strategic Vision with overarching goals and strategic objectives that provided a general blueprint on novel ways to address critical challenges and questions (e.g., related to health promotion, social determinants of health, health inequities, and resilience). The NHLBI Division of Cardiovascular Sciences (DCVS) identified six scientific focus areas that demonstrate a cross-cutting and multifaceted approach to implementing the strategic vision as it relates to cardiovascular sciences. These are social determinants of health, resilience, promoting cardiovascular health, heart failure, vascular dementia and hypertension. More information on the six areas are available here: https://www.ahajournals.org/doi/pdf/10.1161/CIRCRESAHA.118.314338.

This Request for Information (RFI) seeks input on opportunities for promoting cardiovascular health and reducing cardiovascular health disparities in mothers and children in vulnerable and diverse populations through home visiting. Workshop reports related to this topic are available on the NHLBI webpage:

  • Promoting Cardiovascular Health in Early Childhood (0-5 years) and Transitions in Childhood through Adolescence - Executive Summary
  • Social Determinants of Health: Contributions of Early Life Adversity to Cardiovascular Disparities in Adulthood Workshop - Executive Summary

Research suggests that the development of risk factors for cardiovascular disease begins at pre-pregnancy and in utero and progresses from infancy through childhood and adolescence into adulthood (1, 2). The loss of cardiovascular health from birth through adulthood is accelerated by adverse clinical cardiovascular outcomes that are influenced by negative risk factors (3, 4) such as poor health behaviors including poor diet and physical activity patterns, sedentary behaviors, excessive weight gain, exposures to tobacco and other substances, adverse childhood experiences, poverty, and social environmental determinants of health including poor access to and utilization of health services. Research on early childhood home visiting models has demonstrated evidence for early intervention services that disrupt negative outcomes for families at risk including first-time parents, low-income parents, single or teen parents, and parents with substance abuse or addictions, or mental health issues such as maternal depression (5,6). However, research gaps remain in understanding whether and how home visiting programs improve cardiovascular health of mothers and children.

Information Requested

Information is requested from the research community, state, tribal, and local government agencies, health care professionals, evidence-based home visiting model developers, early intervention providers, representatives of health and/or home visiting advocacy organizations, members of scientific or professional organizations, community-based organizations, or other interested stakeholders on the categories below. Responses may include but are not limited to the following categories:

Intervention Implementation Needs

  • Opportunities that would make significant contributions to improved cardiovascular health of mothers and children participating in evidence-based home visiting programs.
  • Enhancements of existing evidence-based home visiting models to address aspects of cardiovascular health and related health outcomes for mothers and children.
  • Improved understanding of the mechanism by which existing home visiting programs/models contribute to improved cardiovascular health in mothers and children.
  • Strategies for coordinating home visiting service delivery with primary care or leveraging other early childhood efforts (e.g., Special Supplemental Nutrition Program for Women, Infants, and Children; community-based organization and resources, Head Start/Early Head Start, Child Care and Development Fund) to enhance cardiovascular health of mothers and children.
  • Strategies for addressing research gaps and dissemination and implementation issues in various evidence-based home visiting models to enhance cardiovascular health of mothers and children.
  • Types of expertise and training that could address maternal and child cardiovascular health within evidence-based home visiting programs.

Measurement needs

  • Feasibility of assessing health outcomes, including cardiovascular health outcomes (e.g., survey- or laboratory- and examination-based outcomes) within the context of evidence-based home visiting service delivery program and models.
  • Challenges in assessing American Heart Association’s Life’s Simple 7 risk factors related to ideal cardiovascular health (i.e. diet, body mass index, physical activity, smoke exposure, cholesterol, glucose, and blood pressure) and other age- and developmentally-appropriate measures within the context of evidence-based home visiting service delivery programs and models.
  • Acceptability of obtaining relevant laboratory and real-time measures of mothers and children or other age- or developmentally appropriate measures of cardiovascular health for mothers and children (e.g., sleep; emotional regulation) within the context of evidence-based home visiting service delivery programs or models.
  • Particular challenges in assessing outcomes in diverse communities, including immigrant communities and American Indian and Alaska Native communities.

Identifying research questions and existing entities

  • Novel research questions and topics on cardiovascular health promotion in maternal and early childhood interventions to advance cardiovascular health.
  • Existing entities (e.g., consortia, research networks, health care systems, community agencies and partnerships, state, tribal and local agencies) capable of engaging in longitudinal research studies on evidence-based home visiting and their effects on cardiovascular health. NIH seeks information on populations underrepresented in research.

How to Submit a Response

All responses to this RFI must be submitted electronically to the following webpage at https://grants.nih.gov/grants/rfi/rfi.cfm?ID=96 by February 7, 2020.

Responses to this RFI are voluntary. Do not include any proprietary, classified, confidential, or sensitive information in your response. The NIH will use the information submitted in response to this RFI at its discretion and will not provide comments to any responder's submission. The collected information will be reviewed by federal staff, may appear in reports, and may be shared publicly on any federal website.

The Government reserves the right to use any non-proprietary technical information in summaries of the state of the science, and any resultant solicitation(s). The NIH may use the information gathered by this RFI to inform the development of future funding opportunity announcements.

This RFI is for information and planning purposes only and should not be construed as a solicitation or as an obligation on the part of the Federal Government, the National Institutes of Health (NIH), or individual NIH Institutes and Centers. No basis for claims against the U.S. Government shall arise as a result of a response to this request for information or from the Government’s use of such information.

Citations

  1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics,128(Suppl 5): S213–S256, 201
  2. Daniels SR, Pratt CA, Hollister EB, Labarthe D, Cohen DA, Walker JR, et al. Promoting cardiovascular health in early childhood and transitions in childhood through adolescence: A workshop report. Journal of Pediatrics, 209, 241-251, 2019.
  3. Steinberger J, Daniels SR, Hagberg N, et al. Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond. A Scientific Statement for Healthcare Professionals from the American Heart Association. Circulation, 134 (12): e236-e255, 2016.
  4. Daniels SR, Pratt CA, and Hayman LL. Reduction of risk for cardiovascular disease in children and adolescents. Circulation, 124 (15): 1673-1686, 2011.
  5. Enoch MA, Kitzman H, Smith JA, Anson E, Hodgkinson CA, Goldman D, & Olds DL. Prospective Cohort Study of Influences on Externalizing Behaviors Across Childhood: Results From a Nurse Home Visiting Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry, 55 (5): 376-382, 2016.
  6. Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr. 168(9):800–806, 2014.

Inquiries

Please direct all inquiries to:

Charlotte A. Pratt, Ph.D.
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute (NHLBI)
Email: nhlbi_enrich@nhlbi.nih.gov

Brian Kit, M.D.
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute (NHLBI)
Email: nhlbi_enrich@nhlbi.nih.gov