This Notice of Special Interest (NOSI) highlights the urgent need for social, behavioral, economic, health communication, and epidemiologic research relevant to the 2019 Novel Coronavirus (SARS-CoV-2) and COVID-19. This NOSI encourages urgent competitive supplements and administrative supplements to existing longitudinal studies that address key social and behavioral questions related to the COVID-19 pandemic, including adherence to and transmission mitigation from various containment and mitigation efforts; social, behavioral, and economic impacts from these containment and mitigation efforts; and downstream health impacts resulting from these social, behavioral, and economic impacts,including differences in risk and resiliency based on gender, race and ethnicity, socioeconomic status, and other social determinants of health.

Background

As people across the United States and the rest of the world respond to the COVID-19 pandemic, the importance of behavioral and social factors in health and illness is being highlighted. Most of the current mitigation efforts are non-pharmacological interventions grounded in social and behavioral principles of prevention (e.g. risk communication, handwashing adherence, physical distancing, working from home, paid sick leave). The evidence base for many of these containment and mitigation efforts is based on limited research from prior influenza and SARS epidemics. However, we have minimal experience with a pandemic of this scope and the impacts of these extensive containment and mitigation efforts on transmission rates. Moreover, we have limited understanding of the impact on the personal and economic costs and downstream health and well-being impacts such as suicide and mental health exacerbations, substance abuse, adoption or reduction in healthy lifestyle behaviors (e.g tobacco use, dietary and physical activity regimens), and stress-based physical disorders.

Research Objectives

To rapidly improve our understanding of the critical social and behavioral aspects of the COVID-19 pandemic, this NOSI encourages submission of applications for urgent competitive revisions or administrative supplements to active grants studying existing longitudinal cohorts, particularly those cohorts with considerable data relevant to COVID-19 social and behavioral factors prior and subsequent to the SAR-CoV-2 outbreak in various locations. These submissions are encouraged to consider four broad areas;

1. Adherence to or transmission reductions from various public health containment and mitigation efforts including but not limited to risk communication, handwashing, disinfecting surfaces, social distancing, self-quarantine, paid sick leave, school closures, and business closures.
2. Economic, social, and personal well-being impacts of these various containment and mitigation actions (e.g., unemployment, social isolation, stress, mental health, substance use, physical activity)
3. The impacts and behavioral responses to misinformation being communicated about COVID-19 and its prevention, treatment and health effects via a range of information channels, including traditional and social media
4. Downstream health effects from these economic, social, and personal impacts including but not limited to substance use/abuse, mental illness, suicide, stress-related physical disorders, and limitations on healthcare access.

In addressing any of the four areas of interest it will be necessary to examine natural variation in individual, family, social, geographic, and structural levels of response, adherence, stigma, and impact using foreign and domestic opportunities, focusing on specific sectors of the population (including but not limited to gender, age group, socioeconomic status, geographic region, race/ethnicity, urban/rural, sexual orientation, gender identity). Investigators are strongly encouraged to include a range of groups and include medically underserved regions and vulnerable populations (e.g. pregnant women, the homeless, prison populations, people with disabilities, those in shelters or residential treatment settings) to the degree possible given the characteristics of their existing cohorts.

Applications are encouraged to leverage existing cohorts that present opportunities for quasi-experimental designs, natural experiments, interrupted time series analyses, computational and statistical modeling, and AI approaches. Applications that propose only descriptive pre-post associations are strongly discouraged. Findings from proposals submitted under this NOSI should generate more precise modeling parameters that could lead to increased accuracy and actionable predictions of use in this or future epidemics, examine underlying mechanisms of these interventions and their impacts, and/or leverage the staggered implementation of these interventions and their impacts in various locations (cities, counties, states, countries) for natural experiments controlling for appropriate confounds.

Responsive applications to this NOSI may include but are not limited to the following:

• Quantify intervention effects on adherence and transmission and the economic and personal impacts of these interventions to generate more precise predictive cost-benefit and cost-effectiveness models.
• Evaluate the effects of preventive interventions on individuals increased adoption of or reduction in lifestyle behaviors, such as healthy diets, physical activity, sedentary behaviors, tobacco use, amount and quality of sleep, and alcohol use
• Evaluate and quantify downstream health effects of these personal and economic impacts of the COVID-19 response on substance use/abuse, mental health, and stress-related physical disorders, as well as interpersonal relations (e.g. interpersonal violence, child abuse).
• Study communication of misinformation, individual susceptibility to misinformation, and methods to counter it.
• Study factors contributing to differences in adherence to various prevention efforts and new strategies to improve adherence. For example, how could game theory, research on altruism, etc., be used to improve social distancing adherence to those at low risk of serious COVID-19?
• Evaluate interventions to ameliorate impacts of aspects of the COVID-19 response (e.g. via prospectively assigned or natural experiments comparing differential interventions by countries, states, communities), including remote or virtual interventions to maximize reach and scalability
• Leverage new data sources (e.g., sensors), data integration (especially at multiple levels of influence), and artificial intelligence and computational modeling approaches into existing studies to address questions related to COVID-19 and its response (e.g., monitoring social distancing or augmenting contract tracing via smartphones and other mobile and social media platforms).
• Leverage nationally representative longitudinal studies to elucidate how COVID-19 related changes in the social, economic, communication, institutional and policy environments differentially affect the health and welfare of people across the life course and in vulnerable populations
• Study prevention practices (hand washing, effectively covering a cough, social distancing, etc.) and factors that influence adherence, including individual and age differences and social network effects.
• Gather unique real-time data for rapid assessments of risk and resiliency factors and outcomes, to guide evolving public health and treatment strategies.
• Evaluate strategies used by health systems to reallocate resources, rapidly train practitioners, communicate preventative practices, and maintain adherence to public health and clinical guidelines, with an interest in those that serve high-risk groups.
• Studies of how social distancing requirements affect the care and well-being of vulnerable populations and their caregivers.
• Examining the impact of healthcare-related stigma, discrimination, harassment, and/or refusal of care on seeking COVID-related healthcare.
• Studies of how social distancing guidelines and requirements are implemented and impact vulnerable populations in institutions, group settings, and other non-traditional settings.
• Studies examining the impact of COVID-19-related changes to the social and economic environment (increases in unemployment, the mandated closure of businesses, and recommendations to limit social interaction) on the health and well-being of individuals, including comparative studies of regional and national approaches.
• Studies examining the extent to which existing age, racial, ethnic, sex, gender identity, sexual orientation, socioeconomic or geographic health disparities are exacerbated by the COVID-19 epidemic, including studies of differential access to and use of healthcare services, and differential access to communication and information about, attitudes toward, and uptake of preventive measures.
• Studies leveraging potential data sources of social, cultural, and exposure risk vulnerability, coupled with electronic health records from medical centers and FQHC encounters, to better understand the accumulation of adversity and stress as a function of the COVID-19 pandemic among those with HLBS diseases and disorders.
• Studies examining individual, family, and/or community stress related to COVID-19 (e.g., virus fears, consequences of social distancing, unemployment, food access) on heart, lung, blood, and sleep diseases and disorders (HLBS) or the management of these diseases, especially among vulnerable populations (i.e., health disparity populations, healthcare workers, first responders, homeless) and/or those with pre-existing cardiovascular disease
• Investigations of changes in health behaviors particularly relevant to HLBS diseases, such as diet, physical activity, and sleep, and whether those changes exacerbate risk or mechanisms of COVID-19 infection, pathology, and outcomes
• Studies of stigma, discrimination, and bias from implementation of COVID-19-related screening and treatment policies that affect HLBS outcomes
• Sustainability of evidence-based guidelines for HLBS using telehealth and in-person visits using behavioral and social incentives (e.g., behavioral economics, support groups online, text messaging, apps and health behavior technologies, etc.) during COVID-19 health service adaptations
• Impact of the built environment on maintaining health-based and wellness prevention programs for cardiopulmonary disease while keeping physical distancing

NICHD Interests
In addition to many areas of interest in the NOSI, NICHD has several additional interests.

NICHD has particular interest in COVID-19-related research on vulnerable populations falling within the NICHD scientific mission area, including pregnant and post-partum women, infants, children, and adolescents; individuals with physical and/or intellectual disabilities; and children who are homeless or in foster care.

NICHD also has particular interest in outcomes falling within its mission, including child abuse and neglect, intimate partner violence, learning outcomes, maternal, infant, child, and adolescent morbidity and mortality, changes in fertility and pregnancy outcomes, and access to health care, including reproductive health care.

Additional research topics of interest to NICHD that fall within the scope of this NOSI include, but are not limited to:

• The roles of living arrangements and family and household characteristics and processes, social and community influences, and social networks on COVID-19-related vulnerabilities, responses, and outcomes.
• Differential impacts of and responses to COVID-19, COVID-19 mitigation efforts and downstream effects mitigation on specific subpopulations, for example, groups defined by age, race/ethnicity, urban/rural location or socioeconomic status.
• Studies of increased usage of telemedicine for routine well baby and pediatric health and developmental screenings and their impact on immunization schedules on child and adolescent health outcomes.
• Studies of the digital divide - children and families without reliable access to the internet now that schools and libraries have closed, and impact on health behaviors and outcomes as well as health care access.
• Studies on increased screen time, digital media use and rapid conversion to homeschooling/distance learning on child and adolescent cognitive and social-emotional development, peer interactions and family functioning.
• Studies examining risk factors, resilience and coping for families experiencing multiple stressors (e.g., health, economic and emotional) and symptomology (e.g., anxiety, depression) and the short and long-term sequelae for child, adolescent and family functioning.

Application and Submission Information

Applications in response to this NOSI must be submitted using the following targeted funding opportunities or subsequent re-issued equivalents:

• PA-18-935 Urgent Competitive Revision to Existing NIH Grants and Cooperative Agreements (Urgent Supplement - Clinical Trial Optional) is intended to provide funds for NIH grantees applying to expand the scope of their active grant.
• PA-18-591 Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional) is intended to provide funds for NIH grantees where the work proposed in the supplement is fully within the scope of the ongoing grant.
• The funding instrument, or activity code, will be the same as the parent award.

When developing applications in response to this NOSI, all instructions in the SF424 (R&R) Application Guide , PA-18-591, and PA-18-935 must be followed, with the following additions:

• The Research Strategy section of the application is limited to 6 pages.
• The award project period of the submission must not exceed two years.
• Application budgets are generally limited to no more than $100,000 direct costs per year. Should the proposed research require a higher budget, the applicant should consult with the program official assigned to the parent award and include a strong justification for the larger budget in the supplement application. The proposed budget must reflect the actual needs of the proposed project.
• The parent award must be active when the supplement application is submitted (e.g. within the originally reviewed and approved project period), regardless of the time remaining on the current project.
• Applications will be accepted on a rolling basis through March 31, 2021 by 5:00 PM local time of the applicant organization. This NOSI expires on April, 1, 2021.
• All applications (including those for multi-project activity codes) must be submitted electronically using a single-project application form package:
• Administrative supplement applications to PA-18-591 must use the application form package with the Competition ID that contains FORMS-E-ADMINSUPP . This FOA will be reissued with application form packages containing FORMS-F-ADMINSUPP on May 25, 2020. Submissions to PA-18-591 must be completed by June 25, 2020 (see NOT-OD-20-026 for details.) Submissions to the reissued FOA will be accepted on or after May 25, 2020 through the expiration date of this Notice. In addition, the process for Streamlined Submissions using the eRA Commons cannot be used for this initiative.
• Competitive revision applications to PA-18-935 must use the application form package with the Competition ID of NOT-OD-20-097-FORMS-E." This FOA will be reissued with a NOT-OD-20-097-FORMS-F package on May 25, 2020. Submissions to PA-18-935 must be completed by June 25, 2020. Submissions to the reissued FOA will be accepted on or after May 25, 2020 through the expiration date of this Notice.
• IMPORTANT: For funding consideration, all applicants must designate NOT-OD-20-097 (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.
• Investigators planning to submit an application in response to the NOSI are strongly encouraged to contact the program officers of the parent award to discuss the proposed project in the context of the parent award.

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