and Human Services (HHS)
EXPIRED
EPIDEMIOLOGY OF ALCOHOL CONSUMPTION AND ALCOHOL-RELATED PROBLEMS IN OLDER PERSONS RELEASE DATE: January 22, 2003 PA NUMBER: PA-03-061 March 2, 2006 (NOT-OD-06-046) Effective with the June 1, 2006 submission date, all R03, R21, R33 and R34 applications must be submitted through Grants.gov using the electronic SF424 (R&R) application. Parent R03 (PA-06-180) and R21 (PA-06-181) funding opportunity announcements have been issued for the submission date of June 1, 2006 and submission dates thereafter. Applications relating to R33 and R34 activities must be in response to NIH Institute/Center (IC)-specific announcements. EXPIRATION DATE: This PA will expire on December 15, 2005, unless reissued. National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://www.niaaa.nih.gov) National Institute on Aging (NIA) (http://www.nia.nih.gov) THIS PA CONTAINS THE FOLLOWING INFORMATION o Purpose of the PA o Research Objectives o Mechanism(s) of Support o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Special Requirements o Where to Send Inquiries o Submitting an Application o Peer Review Process o Review Criteria o Award Criteria o Required Federal Citations PURPOSE OF THIS PA The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Aging (NIA) invite applications for research on the epidemiology of alcohol consumption and alcohol-related problems in older persons with the goal of enhancing our understanding of patterns of alcohol consumption and the epidemiology of alcohol-related problems in older populations. Research objectives of this program announcement include, but are not limited to: (1) studying patterns of alcohol consumption and the distribution of alcohol-related problems in the older and elderly population as a whole and in specific sub-populations of this group; (2) studying risk and protective factors for alcohol-related problems in the older and elderly population as a whole and in specific subpopulations of this group; (3) elucidating disparities among racial/ethnic groups of older and elderly persons with respect to alcohol consumption and alcohol-related problems; (4) understanding the natural history, course, and short- and long-term outcomes of alcohol consumption among older and elderly persons. RESEARCH OBJECTIVES BACKGROUND There are two compelling reasons to study alcohol consumption and alcohol-related problems among older people in the United States. The first is demographic. Older people are the fastest growing segment of the population. According to the 2000 US census, there are about 59 million Americans over 55, 35 million over 65, 17 million over 75 and 4.2 million over 85 (US Census Bureau). The Census Bureau estimates that by 2010, these numbers will be about 75, 40, 19 and 5.8 million, respectively and by 2020, about 96, 54 22 and 6.8 million, respectively (US Census Bureau). The older population is growing dramatically both in absolute numbers, as well as relative to other age groups in the populations. By 2020, one in six Americans will be over the age of 65. The second is the fact that older persons differ biologically, psychologically and socially from younger people. As a result, they have different health and other needs and utilize different community and national resources. More specifically, older persons differ from younger persons in levels and patterns of alcohol consumption, in their biological response to alcohol, and in terms of the problems they may experience or benefits they may accrue from this consumption. These factors have important public health ramifications. Currently, we have insufficient knowledge about alcohol consumption in this population, the incidence and prevalence of the alcohol-related problems older people experience and the risk and protective factors associated with their problems. In order to prepare appropriately to meet the alcohol-related health needs of the US population as it ages, we must address these gaps in our knowledge through well designed studies, including clinical trials, longitudinal, and cross-sectional studies. The later years of life are variously described and subdivided. One such categorization is: later adulthood (age 60 plus); late adult transition (ages 60-65); the elderly (65 plus): the young old (60-75); the old, old (75 plus); and the frail elderly or the very old (80 plus) (Zucker, 1996). No matter how it is described or segmented, this time of life represents a broad span of years and a heterogeneous group of people who vary widely in age, fitness, income and many other ways. In later life, as in adolescence, there is a confluence of multiple transitions and developmental challenges; there are changes in roles and responsibilities, as well as physical, social, psychological and cognitive changes. Many may be difficult. Retirement may result in a loss of routine, income, sense of purpose and self-worth, as well as increased loneliness and too much unstructured time. Losses of friends and spouses may occur adding to loneliness and loss of purpose. Some may turn to alcohol as a result. In addition, changes in living arrangements (e.g. moves into retirement communities, nursing homes or other age-segregated settings) and physical problems, including sleep problems and pain, may cause some older persons to turn to alcohol or to increase consumption. Not only is America's population graying, but cohorts of persons aging currently (e.g. the so called baby boomers) consumed more alcohol and other substances during their early and middle years than the current cohort of elderly persons. As a result, they may be more likely to continue to use or to turn to alcohol as a coping mechanism in their later years than the current older generation. In addition, we know that some people increase their alcohol consumption later in life, often leading to late-onset alcoholism (Atkinson, 1995). In fact, late onset problem drinkers may constitute as many as one-third to one-half of older problem drinkers (Brennan and Moos, 1996). However, the etiologic agents which produce late onset drinking have not been well described. An older person's biological reaction to alcohol is quite different than a younger person's. There is clear evidence that aging results in a higher blood alcohol concentration (BAC) for a given dose of alcohol for a person of a given body weight (Watson et al., 1980). Since there is a decrease in body water with age and since alcohol is water- soluble, small amounts of alcohol may result in higher BACs in older than in younger persons (Dufour and Fuller, 1995). The research is mixed regarding the existence of an age-related decrease in alcohol dehydrogenase, an enzyme which starts to break down alcohol before it reaches the bloodstream (Kechigas et at., 2001; Beresford, 1995). In addition, elimination of alcohol from the body is less efficient as people age. There is also good evidence that the elderly show greater effects of alcohol consumption (e.g. incoordination) at the same BAC, indicating decreased tolerance and increased sensitivity (Dufour and Fuller, 1995; Kalant, 1998; Poikolainen, 1984). Because of these biological changes, light to moderate, not just heavy or dependent use, among older populations can be a health risk and an elderly person may experience alcohol-related problems even though his or her drinking patterns have not changed. Although the specific effects of alcohol on the older, as compared to the younger, brain are largely unknown, they are presumed to be different. It is also hypothesized that alcohol may exacerbate or accelerate brain degeneration of varying etiology in the elderly (Adams WL, 1999; Tyas, 2001). Alcohol may also affect the health of an older person by exacerbating sleep problems (Aldrich, 1996, Block, 1986), elevating blood pressure (Camargo et al., 1997) and negatively affecting bone mineral metabolism (Ganry et al., 2000; Hannan et al., 2000). Alcohol use in the elderly is also associated with hip fractures due to falls (Rose and Maffulli, 1999) and other unintentional injuries including automobile crashes (Higgins et al., 1996). The increased risk of hemorrhagic stroke seen in the general population may be especially important in this age group (English, 1995; Hillbom and Juvela, 1996). Consumption of over one to two drinks a day poses significant risks for cancer (Bagnardi et al, 2001), liver cirrhosis, brain damage, and unintentional injuries (Friedman and Klatsky 1993; Rehm and Sempos 1995). On the other hand, there is evidence of benefits from modest alcohol use. Low to moderate consumption may offer some protection against cardiovascular disease (CVD) , including ischemic stroke, especially for those at moderate risk for CVD (Mukamal and Rimm, 2001) and some studies have shown increased bone mineral density in postmenopausal women who drink at moderate levels (Mukherjee et al., 2000; Rapuri et al., 2000; Turner and Sibonga, 2001). The majority of older persons take medications, and alcohol interacts adversely with many prescription and over the counter drugs. Studies indicate that between 60 to 90 percent of elderly persons use some form of medication, often more than one at a time (Chriscilles et al., 1992; Dufour et al., 1992; Pollow et al. 1994). Medications commonly taken by older people which have a high potential for a negative reactions with alcohol include analgesics, antihypertensives, anticoagulants, diuretics, antiarthritics and psychoactive agents (Forster et al, 1993). Also significant is the fact that the diagnosis of alcohol abuse can be difficult in older people because its symptoms can be erroneously attributed to other medical or psychiatric conditions which are common in this age group (e.g. depression, insomnia, poor nutrition, and frequent falls) or to medication side-effects. Hospital staff are significantly less likely to recognize alcohol problems in an older than in a younger patient (Curtis et al., 1989; Reid and Anderson, 1997). In fact, physicians rarely ask their older patients about alcohol consumption. In addition, DSM criteria may be difficult or even inappropriate to use with elderly persons (Gomberg, 1990). Some studies indicate a significant proportion of "hidden" alcoholics may be over 60 years of age (Cox et al., 1997). There is an urgent need for better epidemiologic information about drinking among older and elderly persons and about the variables that influence drinking in this population. Clearly, the factors which promote or sustain alcohol use are different in older compared to younger persons, as are the consequences of drinking. Well-designed, focused, clinical, cross-sectional and longitudinal (both long and short-term) studies are needed to better identify the parameters of alcohol consumption and alcohol-related problems among the elderly, and delineate causal structure. Enhanced understanding of the interplay of multiple factors in the determination of drinking behavior, better specification of the risks for, benefits of, and short and long-term consequences of drinking among older persons, is needed to address the alcohol-related prevention and treatment needs of a growing elderly population. Areas of Research Interest Broadly stated the research objectives of this initiative are to: (1) study patterns of alcohol consumption and the distribution of alcohol- related problems in the older and elderly population as a whole and in specific sub-populations of this group; (2) study risk and protective factors for alcohol-related problems in the among the older and elderly population as a whole and in specific subpopulations of this group; (3) elucidate disparities among racial/ethnic groups of older and elderly persons with respect to alcohol consumption and alcohol-related problems; (4) understand the natural history, course, and short- and long-term outcomes of alcohol consumption among older and elderly persons. More specifically the objectives of this initiative include, but are not limited to: - Increasing knowledge about the incidence, prevalence, etiology, course, and natural history of alcohol-related problems, including alcohol abuse and alcohol dependence, among older and elderly populations, and among subgroups of this population (e.g. racial/ethnic groups, men and women, the very old, those in group housing). - Examining the relationship of alcohol consumption and alcohol abuse and dependence to other psychiatric disorders and conditions among older and elderly populations. - Examining the relationship of alcohol consumption to the development, course and outcomes of physical illnesses including heart disease, cancer, liver disease and degenerative brain disorders in older and elderly populations. - Exploring patterns of alcohol consumption (e.g., frequency, quantity, duration, beverage type) which may increase or decrease risk for particular alcohol-related problems among older and elderly populations. - Exploring combined patterns of prescription and over the counter medication use (e.g. regular vs. intermittent use, type of medication) and alcohol consumption (e.g., frequency, quantity, duration, beverage type) which may increase or decrease risk for particular alcohol- related problems and/or adverse alcohol-medication interactions among older and elderly populations. - Increasing knowledge about risk and protective factors (personal, environmental and genetic) for alcohol-related problems among older and elderly populations. - Elucidating factors associated with the initiation of and abstinence from drinking among older and elderly persons. - Elucidating the role of alcohol consumption in intentional and unintentional injury, including falls, vehicular crashes and suicide in older and elderly persons. - Conducting longitudinal follow-up studies in older and elderly populations to determine the relationships between personal, sociocultural and genetic factors in the development, course and short and long-term outcomes of alcohol-related problems. MECHANISM(S) OF SUPPORT This PA will use the NIH Research Project grant (RO1), Small Grant (R03), and Exploratory/Development grant (R21) award mechanisms. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project. Applications for R01s may request support for up to 5 years. Facilities and Administrative (F&A) costs will be awarded based on the negotiated rate at the time of the award. Under the Small Grant mechanism (R03) applicants may request either $25,000 or $50,000 in direct costs per year for up to two years. These awards are not renewable; however, a no-cost extension of up to one year may be granted to the grantee institution prior to expiration of the project period. Before completion of the R03, investigators are encouraged to seek continuing support for research through a research project grant (R01). (See Program Announcement PA-99-098, "NIAAA Small Grant Program," http://grants.nih.gov/grants/guide/pa-files/PAR-99-098.html, for a complete description of the R03 mechanism.) Exploratory/developmental grants (R21) are limited to 3 years for up to $100,000/year for direct costs. (See Program Announcement PA-99-131, "NIAAA Exploratory/Developmental Grant Program," http://grants.nih.gov/grants/guide/pa-files/PA-99-131.html, for a complete description of the R21 mechanism.) Exploratory/Developmental Grants and Small Grants cannot be renewed: however, a no-cost extension of up to one year may be granted prior to expiration of the project period. Investigators are encouraged to seek continued support after completing an Exploratory/Developmental Grant project or a Small Grant project through a Research Project Grant (R01). This PA uses just-in-time concepts. It also uses the modular budgeting format. (see http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if you are submitting an application with direct costs in each year of $250,000 or less, use the modular format. ELIGIBLE INSTITUTIONS You may submit (an) application(s) if your institution has any of the following characteristics: o For-profit or non-profit organizations o Public or private institutions, such as universities, colleges, hospitals, and laboratories o Units of State and local governments o Eligible agencies of the Federal government o Domestic or foreign o Faith-based or community-based organizations INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH programs. WHERE TO SEND INQUIRIES We encourage your inquiries concerning this PA and welcome the opportunity to answer questions from potential applicants. Inquiries may fall into two areas: scientific/research and financial or grants management issues: o Direct your questions about scientific/research issues to: Rosalind Breslow, PhD, MPH Division: Biometry and Epidemiology Institute or Center: NIAAA Building Willco, Room 514 Bethesda, MD 20892 Telephone: (301) 594-6231 FAX: 301-443-8614 Email: [email protected] Angie Chon-Lee, MPH Behavioral and Social Research Program National Institute on Aging 7201 Wisconsin Avenue, Suite 533, MSC 9205 Bethesda, MD 20892-9205 Telephone: (301) 496-3138 FAX: (301) 402-0051 Email: [email protected] (e-mail correspondence is preferred) o Direct your questions about financial or grants management matters to: Judy Fox Chief, Grants Management Branch Office of Planning and Resource Management National Institute on Alcohol Abuse and Alcoholism Willco Building, Suite 504 6000 Executive Boulevard, MSC 7003 Bethesda, MD 20892-7003 (301) 443-4704 (telephone) (301) 443-3891 (fax) email: [email protected] Linda Whipp Grants and Contracts Management Office National Institute on Aging 7201 Wisconsin Avenue, Suite 2N212, MSC 9205 Bethesda, MD 20892 Telephone: (301) 496-1472 FAX: (301) 402-3672 Email: [email protected] (e-mail correspondence is preferred) SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 710-0267, Email: [email protected]. APPLICATION RECEIPT DATES: Applications submitted in response to this program announcement will be accepted at the standard application deadlines, which are available at http://grants.nih.gov/grants/dates.htm. Application deadlines are also indicated in the PHS 398 application kit. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting up to $250,000 per year in direct costs must be submitted in a modular grant format. The modular grant format simplifies the preparation of the budget in these applications by limiting the level of budgetary detail. Applicants request direct costs in $25,000 modules. Section C of the research grant application instructions for the PHS 398 (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html includes step- by-step guidance for preparing modular grants. Additional information on modular grants is available at http://grants.nih.gov/grants/funding/modular/modular.htm. SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: Applications requesting $500,000 or more in direct costs for any year must include a cover letter identifying the NIH staff member within one of NIH institutes or centers who has agreed to accept assignment of the application. Applicants requesting more than $500,000 must carry out the following steps: 1) Contact the IC program staff at least 6 weeks before submitting the application, i.e., as you are developing plans for the study; 2) Obtain agreement from the IC staff that the IC will accept your application for consideration for award; and, 3) Identify, in a cover letter sent with the application, the staff member and IC who agreed to accept assignment of the application. This policy applies to all investigator-initiated new (type 1), competing continuation (type 2), competing supplement, or any amended or revised version of these grant application types. Additional information on this policy is available in the NIH Guide for Grants and Contracts, October 19, 2001 at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the checklist, and five signed photocopies in one package to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 Bethesda, MD 20817 (for express/courier service) APPLICATION PROCESSING: Applications must be received by or mailed on or before the receipt dates described at http://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR will not accept any application in response to this PA that is essentially the same as one currently pending initial review unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of a substantial revision of an application already reviewed, but such application must include an Introduction addressing the previous critique. PEER REVIEW PROCESS Applications submitted for this PA will be assigned on the basis of established PHS referral guidelines. An appropriate scientific review group convened in accordance with the standard NIH peer review procedures (http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific and technical merit. As part of the initial merit review, all applications will: o Receive a written critique o Undergo a selection process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed and assigned a priority score o Receive a second level review by the appropriate national advisory council or board REVIEW CRITERIA The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments, reviewers will be asked to discuss the following aspects of your application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals: o Significance o Approach o Innovation o Investigator o Environment The scientific review group will address and consider each of these criteria in assigning your application's overall score, weighting them as appropriate for each application. Your application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, you may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) SIGNIFICANCE: Does your study address an important problem? If the aims of your application are achieved, how do they advance scientific knowledge? What will be the effect of these studies on the concepts or methods that drive this field? (2) APPROACH: Are the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Do you acknowledge potential problem areas and consider alternative tactics? (3) INNOVATION: Does your project employ novel concepts, approaches or methods? Are the aims original and innovative? Does your project challenge existing paradigms or develop new methodologies or technologies? (4) INVESTIGATOR: Are you appropriately trained and well suited to carry out this work? Is the work proposed appropriate to your experience level as the principal investigator and to that of other researchers (if any)? (5) ENVIRONMENT: Does the scientific environment in which your work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application will also be reviewed with respect to the following: PROTECTIONS: The adequacy of the proposed protection for humans, animals, or the environment, to the extent they may be adversely affected by the project proposed in the application. INCLUSION: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria included in the section on Federal Citations, below) DATA SHARING: The adequacy of the proposed plan to share data. BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. AWARD CRITERIA Applications submitted in response to a PA will compete for available funds with all other recommended applications. The following will be considered in making funding decisions: o Scientific merit of the proposed project as determined by peer review o Availability of funds o Relevance to program priorities REQUIRED FEDERAL CITATIONS MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components involving Phase I and II clinical trials must include provisions for assessment of patient eligibility and status, rigorous data management, quality assurance, and auditing procedures. In addition, it is NIH policy that all clinical trials require data and safety monitoring, with the method and degree of monitoring being commensurate with the risks (NIH Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html). INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported clinical research projects unless a clear and compelling justification is provided indicating that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing clinical research should read the AMENDMENT "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research - Amended, October, 2001," published in the NIH Guide for Grants and Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_ 2001.htm. The amended policy incorporates: the use of an NIH definition of clinical research; updated racial and ethnic categories in compliance with the new OMB standards; clarification of language governing NIH-defined Phase III clinical trials consistent with the new PHS Form 398; and updated roles and responsibilities of NIH staff and the extramural community. The policy continues to require for all NIH- defined Phase III clinical trials that: a) all applications or proposals and/or protocols must provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) investigators must report annual accrual and progress in conducting analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: The NIH maintains a policy that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at http://grants.nih.gov/grants/funding/children/children.htm. REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. Applicants may wish to place data collected under this PA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This PA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople. AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance No. 93.273 and 93.866, and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284)and administered under NIH grants policies described at http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. The PHS strongly encourages all grant recipients to provide a smoke- free workplace and discourage the use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. REFERENCES Adams WL. Alcohol and the health of aging men. Med Clin North Am. Sep;83(5):1195-1211, 1999. Aldrich MS. Effects of alcohol on sleep. In: Lissansky Gomberg, ES et al., eds. Alcohol Problems and Aging. NIAAA Research Monograph No. 33. NIH Pub. No. 98-4163. Bethesda, MD: NIAAA. 1996. Atkinson RM, Tolson RL, Turner JA. Late versus early onset problem drinking in older men. Alcohol Clin Exp Res. Aug;14(4):574-9, 1990. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. Alcohol consumption and the risk of cancer. A meta-analysis. Alcohol Res Health.;25(4):263- 70, 2001. 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