Key Dates

Related Announcements

NOT-HD-23-011 - Notice of Participation of the NICHD in NOT-MD-23-003, "Notice of Special Interest (NOSI): Addressing Health Disparities Among Immigrant Populations Through Effective Interventions".

PA-20-183 - NIH Research Project Grant (Parent R01 Clinical Trial Required)

PA-20-184 NIH Research Project Grant (Parent R01 Basic Experimental Studies with Humans Required)

PAR-22-105 - Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)

PAR-22-145 - Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional)

PAR-21-358 - Risk and Protective Factors of Family Health and Family Level Interventions (R01 - Clinical Trial Optional)

Issued by

National Institute on Minority Health and Health Disparities (NIMHD)

National Eye Institute (NEI)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

National Institute on Drug Abuse (NIDA)

National Cancer Institute (NCI)

All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.

Office of Research on Women's Health (ORWH)

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Purpose

The purpose of the immigrant health initiative is to support research to design and implement effective interventions to enhance health advantages and reduce health disparities among U.S. immigrant populations (particularly agricultural workers, unaccompanied minors, first generation immigrants, and children of immigrant families) and address factors related to immigration experiences that affect health. For this Notice of Special Interest (NOSI), the term "1st generation" refers to people who were born outside of the U.S. and its territories and relocated to the U.S. The term "2nd generation" refers to the U.S. born children of 1st generation immigrants.

Background and Goals

In 2022, the U.S. immigrant population was 47 million accounting for 14.3% of the population and this population is expected to almost double within the next 4 decades. Census data indicates that approximately 18% of U.S. immigrants are under 15 years of age. Immigrant families have incomes below the federal poverty level and 41% of today's new immigrants tend to have a high school education-equivalent or less. These data do not reflect the changing situation for most immigrants as they settle into a range of communities, acculturate to different social and cultural values, food choices, employment and educational opportunities, and health challenges.

Factors associated with immigration processes prior to and while deciding to immigrate, during the migration experience, and throughout the course of becoming accustomed to a new environment can translate into higher risk for diseases in the face of multilevel challenges when settling into the U.S. Many immigrants also face multiple ongoing challenges, such as lower health literacy, lack of health insurance, limited English proficiency, other barriers to effective patient-clinician communication, other limitations in accessing health care as well as maintenance of selected traditional health practices. Discrimination and prejudice are common and affect the daily experiences of individuals and organizations within the host society. Structural factors such as local and national laws and policies, the availability of affordable housing, suitable employment and employment benefits, schools for children, and local infrastructure that hinders or facilitates mobility to jobs, schools, medical attention, among other things may undermine well-being and increase stress on new arrivals and long-time immigrants with severe health issues.

Health disparities for specific conditions among immigrant populations are well documented. Yet, most immigrants tend to have better health outcomes than U.S. born populations, despite the adversities they encounter. Despite numerous challenges facing 1st generation immigrants, recent immigrants have reported better health outcomes than U.S. born populations, a status that is thought to deteriorate with increasing length of U.S. residence and in subsequent generations increasing one’s risk for chronic disease. More research is needed to understand the drivers of the immigrant paradox, protective and resiliency factors, health advantages, and why later generations may experience worse health outcomes and how to sustain and promote protective factors.

Risk factors and disease outcomes also vary by immigrant subpopulations based on their country of origin; yet many studies consider immigrants as homogeneous groups according to their region of origin (e.g., Latin America, Asia, Africa), despite different languages, cultures, U.S. policies, and immigration experiences. For example, U.S. immigrants from approximately 20 Latin American countries are treated as one Hispanic/Latino group and not separated into subpopulations based on country of origin and/or ethnic group. Asians (from more than 30 countries) or Africans (from over 20 countries) are treated as one immigrant population when the health outcomes often vary by subpopulations. More research is needed to better understand the risk and protective factors unique to each immigrant subpopulation.

Most research on immigrant health does not consider factors and processes (e.g., civil unrest, financial goals, education, armed conflict, exposure to criminal violence) that spur the migration of groups or subsets of groups from one’s country of origin. Little attention has been given to the pre-existing experiences and/or trauma (e.g., starvation resulting from rapid environmental changes, changing food sources, violent outbreaks, exposures to toxic chemicals and pesticides), and how the experience of migration itself, or how the process of adjustment and adaptation to a new cultural, social, political, and ecological environment may affect health outcomes. Also, it is imperative to consider the receiving communities where immigrants settle and the potential effects on one’s health. Likewise, it is essential to consider the period(s) in the life course when migration occurs and how that experience may affect health outcomes.

Given current knowledge on the determinants of immigrant health, (e.g., social, environmental, behavioral, and structural) and the mechanisms driving these factors to influence health status, a well-developed intervention research framework and multilevel approach are needed to adequately address immigrant health disparities.

Research Objectives:

This NOSI calls for multidisciplinary and multilevel research focusing on the design and implementation of effective interventions addressing immigrant-specific factors to promote health advantages and reduce health disparities, particularly among migrant workers, recent and 1st generation immigrants. Research should focus on improving the health outcomes among immigrant populations by targeting the complex causes or consequences of health disparities.

Investigators are strongly encouraged to employ a common set of tools and resources that will promote the collection of comparable data on social determinants of health (SDOH) across studies. Studies should incorporate measures from the Core and Specialty collections that are available in the SDOH Collection of the PhenX Toolkit (www.phenxtoolkit.org).

Applications should include multidisciplinary intervention research to target multiple factors causing health disparities among underserved immigrant populations. Projects that examine or address factors at multiple levels are strongly encouraged (see the NIMHD Research Framework for examples of determinants of health at different levels:https://www.nimhd.nih.gov/about/overview/research-framework/nimhd-framework.html). Studies may include interventions to foster positive interactions and more inclusive social climates in schools, workplaces, and organization/institution level strategies to improve access to healthy foods, or safe recreational spaces to improve immigrant health.

A life course perspective is encouraged with interventions focusing attention on critical life stages and transition points across the lifespan and associated risk and protective factors for immigrant populations. Such an approach should emphasize the fact that early life disadvantages need not lead to later negative health outcomes, provided there are compensatory experiences during the intervening years. Attention is encouraged to the migration experiences, cultural values, and related health practices, to how the experience of migration itself, or adjustment, adaptation and assimilation to a new cultural, social, political, and ecological environment may affect health outcomes. Intervention should focus on improving and or sustaining resiliency and protective factors in the lives of immigrants that may buffer the effects of adversity and reduce risk for chronic diseases and conditions.

Interventions are encouraged that are culturally appropriate and community-based addressing immigration specific population level factors to overcome barriers to improve overall health and reduce health disparities among immigrants. Projects should involve collaborations among relevant stakeholders in U.S. immigrant population groups, such as community organizations, healthcare providers, public health organizations, consumer advocacy groups, and faith-based organizations. As appropriate for the research questions posed, inclusion of key immigrant community members in the conceptualization, planning and implementation of the research is encouraged to generate better-informed hypotheses and enhance the translation of research results into practice.

Applications are encouraged to utilize rigorous, innovative, multidisciplinary approaches addressing social and behavioral factors combined with biological assessments to show whether they may serve as measurable indicators for excess risk of health outcomes. Studies that include a focus on preventing and reducing chronic diseases and comorbidities are encouraged. Studies to conduct only needs assessments or interventions designed to increase knowledge as a sole outcome will not be supported under this NOSI.

Projects must include a focus on immigrants from one or more NIH-designated populations who experience health disparities in the U.S., which includes racial and ethnic minorities (Blacks or African Americans, Hispanics/Latinos, Asian Americans, and Pacific Islanders). Studies focused on exploring the immigration experience of residents of U.S. territories (Guam, Puerto Rico, American Samoa, Commonwealth of the Northern Mariana Islands, and US Virgin Islands) to the contiguous U.S. are encouraged. Please see: https://www.nimhd.nih.gov/about/overview/ for more information.

Please note that exclusion of non-English speaking participants without compelling scientific justification (e.g., studies focused on second-generation immigrant youth) is discouraged and that appropriate translation services should be provided for in the research plan and the budget.

Research is encouraged among distinct immigrant subpopulations based on the country of origin, rather than larger racial/minority populations when feasible (e.g., Koreans, Vietnamese, or Cambodians rather than Asian Americans). For projects involving comparisons across populations, these comparisons should illuminate immigrant-specific phenomena rather than represent more global comparisons between immigrants with Whites or the general U.S. population. Examples of appropriate comparisons may include, but are not limited to:

• Immigrant subpopulations within the same racial/ethnic minority group (e.g., Nicaraguan immigrants vs. Mexican immigrants vs. Puerto Rican residents who migrate to the continental U.S.)
• Immigrants across racial/ethnic minority populations sharing similar experiences in the U.S. (e.g., Southeast Asian immigrant garment workers vs. Mexican immigrant garment workers) or from the same racial/ethnic minority population that work in different labor markets (e.g., Mexican agricultural workers vs. Mexican construction workers vs. Mexican meat processing workers)
• Immigrants with their U.S. born counterparts (Chinese immigrants vs. U.S. born Chinese Americans)

Research Topics

Specific research topics of interest on multilevel interventions among immigrant populations in the U.S. may include, but are not limited to:

• Develop innovative strategies to address structural factors in multiple sectors (i.e., education, transportation, labor) that influence the living conditions and result in health advantages or health disparities
• Determine and address stress related to stigma, discrimination, trauma, uncertainty, social isolation, acculturation, and other experiences faced by immigrants that affect health
• Address exposures to adversities and chronic stress during the immigration process that results in worsened health outcomes
• Address and bolster social and cultural factors at individual, family and/or community levels that may enhance resilience and protective factors through the immigration experience among subpopulations, resulting in health advantages
• Develop and sustain community-level culturally informed health promotion strategies and programs (e.g., access to healthy foods, safe recreational spaces, screening programs) to promote immigrant health
• Address culturally specific beliefs and practices for health promotion and chronic disease prevention among various immigrant subpopulations, specifically where traditional health practices may be the preferred and/or integrated with(in) medical practice in healthcare systems
• Test the effectiveness of existing or new technologies to address language and other barriers in accessing health care and health information among populations with limited English proficiency
• Develop strategies to improve mental and physical health by fostering bidirectional positive interactions, social support, programs, and more inclusive social climates in schools, workplaces, or communities
• Address health care team or organizational-level factors (systems) that facilitate the treatment delivery and follow-up care
• Address systematic barriers to care and accommodate cultural and individual diversity for multiple subpopulations
• Adapt evidence-based interventions to ensure cultural relevance for those with limited-English proficiency and low health literacy in low resource settings to improve quality of care and health outcomes
• Develop targeted prevention strategies for different subpopulations to address screening disparities for preventable chronic diseases, comorbidities, or conditions
• Develop strategies focusing on key transition points across the lifespan and associated risk and protective factors to improve overall health
• Develop strategies to address structural racism and discrimination affecting health outcomes
• Examine how different strategies to address social determinants (such as housing, employment, or educational systems) may increase reach/access to prevention and care in low-resource settings for (sub)populations
• Test early diagnosis strategies for infectious diseases, such as HIV, by employing rapid testing strategies and referrals to care
• Test strategies to promote well-being, health, and reduce injury within the workplace
• Develop structural or system-level interventions to address cultural, cognitive or behavioral processes that create barriers to health care use, regular preventive screenings, or vaccination uptake

National Eye Institute

The mission of the National Eye Institute (www.nei.nih.gov) is to eliminate vision loss and improve quality of life through vision research. The NEI invites applications that address research topics relevant to mechanisms of visual function, prevention and treatment of eye diseases, and strategies to expand opportunities for people who are blind or have low vision.

Examples of interventions include but are not limited to community interventions (e.g., workplace or school-based vision health outreach, promotion, and education programs about primary eye diseases such as myopia and other degenerative disorders or secondary eye diseases such as complications to diabetes); and/or may involve the use of digital health technologies (e.g., imaging-based artificial intelligence (AI) decision support systems, teleophthalmology, teleoptometry, and other mobile health tools) that aid in the screening, early detection, prevention, diagnosis, assessment, and management of eye diseases and vision disorders among people who immigrated to the United States.

All investigators are encouraged to contact the NEI Scientific/Research program director in advance of submission. NEI will not support clinical trials that are greater than minimal risk submitted through this NOSI. Minimal risk is defined as the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.

Application and Submission Information

This notice applies to due dates on or after June 5, 2023 and subsequent receipt dates through June 8, 2026.

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. Applicants should verify that the target Institute/Center to which they intend to apply participates in the FOA through which they will apply.

• PA-20-183 - NIH Research Project Grant (Parent R01 Clinical Trial Required)
• PA-20-184 NIH Research Project Grant (Parent R01 Basic Experimental Studies)
• PAR-22-105 - Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)
• PAR-22-145 - Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional)
• PAR-21-358 - Risk and Protective Factors of Family Health and Family Level Interventions (R01 - Clinical Trial Optional)

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-MD-23-003 (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

Scientific/Research Contact(s)

Randy Capps, PhD
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Telephone: 301-827-5423
Email: randy.capps@nih.gov

Deborah E. Linares, Ph.D., M.A.
NIMHD
Telephone: 301-402-2516
Email: Deborah.linares@nih.gov

Crystal Barksdale, PhD, MPH
NIMHD
Telephone: 301-402-1366
E-mail: crystal.barksdale@nih.gov

Rada K Dagher, Ph.D., M.P.H.
?NIMHD
Telephone: 301-451-2187
Email: rada.dagher@nih.gov

Michelle Doose, PhD, MPH
National Cancer Institute (NCI)
Telephone: 240-276-7674
Email: michelle.doose@nih.gov

Jimmy Toan Le, ScD, MA
NEI
Phone: 301-435-8160
E-mail: jimmy.le@nih.gov

Tatiana Balachova, Ph.D.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Telephone: 301-443-5726
Email: Tatiana.Balachova@nih.gov

Mary Theresa Macdonald
National Institute on Drug Abuse (NIDA)
Phone: 301-827-6239
E-mail: mary.macdonald@nih.gov

Damiya Eve Whitaker, PsyD, MA
Office of Research on Women's Health (ORWH)
Phone:301-451-8206
E-mail: damiya.whitaker@nih.gov

Randy Capps, PhD
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Telephone: 301-827-5423
Email: randy.capps@nih.gov

Financial/Grants Management Contact(s)

Margaret Young
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Telephone: 301-642-4552
Email: margaret.young@nih.gov

Priscilla Grant, J.D.
NIMHD
Telephone: 301-594-8412
Email:grantp@mail.nih.gov

Crystal Wolfrey
National Cancer Institute (NCI)
Phone: (240) 276-6277
E-mail: wolfreyc@gab.nci.nih.gov

Karen Robinson-Smith
NEI
Phone: 301-435-8178
E-mail: kyr@nei.nih.gov

Judy Fox
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Telephone: 301-443-4707
Email: jfox@mail.nih.gov

Margaret Young
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Telephone: 301-642-4552
Email: margaret.young@nih.gov