Expired PA-13-246: Research to Characterize and Reduce Stigma to Improve Health (R21)

Part 1. Overview Information

Participating Organization(s)	National Institutes of Health (NIH)
Components of Participating Organizations	National Institute on Aging (NIA) National Cancer Institute (NCI) National Human Genome Research Institute (NHGRI) National Institute on Deafness and Other Communication Disorders (NIDCD) National Institute of Mental Health (NIMH) National Institute of Neurological Disorders and Stroke (NINDS)
Funding Opportunity Title	Research to Characterize and Reduce Stigma to Improve Health (R21)
Activity Code	R21 Exploratory/Developmental Research Grant Award
Announcement Type	New
Related Notices	NOT-OD-16-004 - NIH & AHRQ Announce Upcoming Changes to Policies, Instructions and Forms for 2016 Grant Applications (November 18, 2015) NOT-OD-16-006 - Simplification of the Vertebrate Animals Section of NIH Grant Applications and Contract Proposals (November 18, 2015) NOT-OD-16-011 - Implementing Rigor and Transparency in NIH & AHRQ Research Grant Applications (November 18, 2015) July 8, 2014 - NIMH Focus for Intervention Studies Submitted Under the Stigma and Health Literacy Announcements. See Notice NOT-MH-14-016. June 4, 2014 - Notice NOT-14-074 supersedes instructions in Section III.3 regarding applications that are essentially the same. August 21, 2013: Removed reference to ASSIST in section IV.3, since ASSIST is currently only available for multi-project applications. May 30, 2013 (NOT-OD-13-074) - NIH to Require Use of Updated Electronic Application Forms for Due Dates on or after September 25, 2013. Forms-C applications are required for due dates on or after September 25, 2013.
Funding Opportunity Announcement (FOA) Number	PA-13-246
Companion Funding Opportunity	PA-13-248, R01 Research Project Grant PA-13-247, R03 Small Grant Program
Number of Applications	See Section III. 3. Additional Information on Eligibility.
Catalog of Federal Domestic Assistance (CFDA) Number(s)	93.866, 93.393, 93.394, 93.395, 93.396, 93.397, 93.398, 93.399, 93.242, 93.172, 93.173, 93.853
Funding Opportunity Purpose	This Funding Opportunity Announcement (FOA) encourages research grant applications to characterize the role of stigma in health, life course development, and aging, both in the U.S. and globally, and to test interventions to prevent or reduce the impact of stigma at the individual, community, health care system, and policy levels. The goal of this FOA is to promote research addressing the health-related aspects of stigma, including the etiology and perpetuation of stigma; its impact on physical and mental health, well-being, life course development, and aging; its influence on health behaviors and on use, access to, and quality of received healthcare services; its contribution to health disparities affecting vulnerable demographic groups; and intervention strategies to reduce health-related stigma and/or the negative health and life course developmental impacts of stigma.

Key Dates

Posted Date	June 14, 2013
Open Date (Earliest Submission Date)	September 16, 2013
Letter of Intent Due Date(s)	Not Applicable
Application Due Date(s)	Standard dates apply, by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
AIDS Application Due Date(s)	Standard AIDS dates apply, by 5:00 PM local time of applicant organization
Scientific Merit Review	Standard dates apply
Advisory Council Review	Standard dates apply
Earliest Start Date	Standard dates apply
Expiration Date	September 8, 2016
Due Dates for E.O. 12372	Not Applicable

Required Application Instructions

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Table of Contents

Part 1. Overview Information
Part 2. Full Text of the Announcement
Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

Research Objectives

Stigma refers to the process by which certain human characteristics are labeled as socially undesirable and linked with negative stereotypes about a class of individuals, resulting in social distance from or discrimination towards labeled individuals. Stigma can be differentiated into enacted stigma, in which labeled individuals are treated differently from or denied opportunities available to non-labeled individuals, and felt or internalized stigma, in which labeled individuals avoid particular situations, interactions, or roles to prevent anticipated stigmatization, and/or endorse negative stereotypes about the group to which they belong.

Stigmatized statuses include those related to certain broadly based or rare health conditions with the potential for depersonalization, physical or mental disabilities, or to demographic characteristics such as race/ethnicity, gender, age, socioeconomic status, sexual orientation, religion or nativity. Individuals from stigmatized demographic groups who have a stigmatized health condition may face the particular challenges of compound stigma. For racial/ethnic minorities, the nature and intensity of stigma surrounding particular health conditions may be greater due to cultural differences in health beliefs and behaviors.

Demographic and policy changes, as well as emerging trends in disease incidence, prevalence, and/or mortality, may increase or decrease the impact of stigma on health outcomes, requiring researchers to continually examine the problem in a new light. For example, global trends in population aging and increases in life expectancy are raising concerns about how societies will manage the health and economic impact of an increasingly large older adult population. At the same time, research on ageism has identified biases and discrimination in health care institutions, workplaces, and the media that perpetuate misconceptions about aging and can put older individuals at risk of under-treatment, under-prioritization, and even abuse or neglect (North & Fiske, Psychological Bulletin, 2012). Older age, the leading risk factor for many chronic diseases, represents just one of many potentially stigmatizing conditions faced by members of our society.

In 2002, the NIH Fogarty international Center and participating NIH institutes released a FOA to encourage global and domestic research on stigma and health (http://www.fic.nih.gov/programs/Pages/stigma.aspx). A significant proportion of the grants were awarded to projects conducted in low and middle income countries, where stigma may exacerbate the effects of limited health care resources. An independent evaluation of the stigma program recommended a second phase of research focusing on community based research to identify and develop interventions to reduce the prevalence and effects of stigma on health and disease in low resource settings (see above web site). Recent NIH portfolio assessments and emerging health trends further indicate that in the case of understudied health conditions or demographic subgroups, research is also needed to characterize the nature and impact of stigma, with the goal of moving the science closer to invention development.

This FOA encourages research on stigma, particularly in health conditions, settings, and populations where it is not well characterized although the burden is high, and/or where the development and implementation of interventions to reduce its detrimental effects are now possible. The R21 mechanism is intended to encourage new exploratory and developmental research projects. For example, such projects could assess the feasibility of a novel area of investigation or a new experimental system that has the potential to enhance health-related research. Another example could include the unique and innovative use of an existing methodology to explore a new scientific area. These studies may involve considerable risk but may lead to a breakthrough in a particular area, or to the development of novel techniques, agents, methodologies, models, or applications that could have a major impact on a field of biomedical, behavioral, or clinical research. Applications submitted under this mechanism should be exploratory and novel. These studies should break new ground or extend previous discoveries toward new directions or applications.

Scientific Scope

The goal of this FOA is to promote research addressing the health-related aspects of stigma, including the etiology and perpetuation of stigma; its impact on physical and mental health and well-being, life course development, and aging; its influence on health behaviors and use, access to, and quality of healthcare services; its contribution to health disparities affecting vulnerable demographic groups; and intervention strategies to reduce health-related stigma and/or the negative health and life course developmental impacts of stigma.

Research approaches of interest include but are not limited to:

Research examining how psychological, social, economic, cultural and political factors operate in the creation and perpetuation of stigma, and how they link to stereotypes, discrimination and mistreatment related to health and health care;
Research examining the how stigma become internalized into self-stereotypes and how these self-stereotypes impact health;
Research examining the actual and potential roles of media in creating, disseminating and intervening in stigma-related attitudes and actions;
Research examining the relationship between attributions about the causes/etiologies of particular diseases and disorders and the degree to which those with, or at risk for, the disorder are stigmatized;
Research examining how stigma affects access to care and treatment, quality of care, and outcomes across health conditions;
Research examining the role of stigma in the quality of the patient/health care practitioner relationship, the role of the provider s attitude in perpetuating stigma, and the role of stigma in disclosure of disease status during medical visits;
Research examining the role of disclosure of disease in an individuals personal or professional life and its relationship to perceived stigma;
Research examining the social, cultural and environmental influences on (a) perceptions of and reactions to stigma/discrimination among individuals, families and communities, and (b) resources available for coping with or ameliorating stigma’s negative health consequences;
Development of approaches to ensure that medical advances, which can be used to treat or prevent stigmatized conditions, effectively reach appropriate populations;
Development of tools to study and document stigma and its impact on accurate determination of incidence and prevalence of health outcomes, and to estimate the risk for over- or under-diagnosis as a result of stigma- related influences;
Development of approaches to minimize (or eliminate) the impact of stigma/stigmatization on the recognition and diagnosis of health conditions and on the availability of options for treatment and/or rehabilitation;
Development of culturally sensitive interventions to combat stigma and the negative effects of stigma;
Evaluation of which interventions work for stigma-related health problems, identification of the characteristics of successful interventions, and demonstration of how successful interventions can be scaled up or generalized to other stigmatized public health problems and/or to other populations and cultures.

With respect to specific conditions or populations, individual institutes and centers at the NIH may have distinct research priorities, such as those listed below. Applicants are encouraged to contact the Scientific/Research Contacts listed in Section VII of this FOA to discuss areas of scientific interest for particular institutes and centers.

National Institute on Aging (NIA)

Stereotypes about aging as a time of infirmity, disengagement, and reduced potential are pervasive in our society and often propagated through the media. These negative expectations may lead people in general, as well as older adults themselves, to underestimate their potential, and may give rise to a cascade of behavioral and psychological processes that undermine health and adaptive aging (When I m 64, National Research Council, 2006, see http://www.nap.edu/catalog.php?record_id=11474 ). Research suggests that individuals own attitudes toward aging can impact a range of clinical and functional health outcomes.

The National Institute on Aging encourages research focused on the health and life course developmental impact of ageism, including self- and other stereotypes of aging, and on how health disparities are exacerbated or perpetuated by stigma. It also encourages research on the health and economic impact of other forms of discrimination, including racial or ethnic discrimination or discrimination arising from lower socioeconomic status, as well as stigma associated with age-related diseases, including dementia. Some of this work may well be served by cross-national research on stigma related to aging and its intersection with other forms of stigma, stereotyping and discrimination.

National Cancer Institute (NCI)

The National Cancer Institute encourages research focused on associations between experienced stigma and biological cancer outcomes; associations between stigma and stress, negative affectivity, and/ or social isolation; ways in which health disparities are exacerbated or perpetuated by stigma. It also encourages research on the health and economic impact of other forms of discrimination, including racial or ethnic discrimination or discrimination arising from lower socioeconomic status, as well as stigma associated with cancer. Another area of interest concerns the influence of stigma on process of care behaviors and medical decisions (e.g., willingness to seek preventive services), particularly among cultures with cancer-related stigma convictions (e.g., Vietnamese and other Asian American populations). Other areas of research include but are not limited to factors that contribute to the internalization of a stigmatized identity; studies that address the role of compounding or interactive stigmatized identities; and, factors that may attenuate or buffer against stigma or stigma-related consequences (e.g., positive affectivity, social support). Of particular interest are intervention or health communication studies aimed at targeting cancer-related stigma and methodological studies aimed at improving detection of cancer-related stigmas.

In the area of cancer and global health, the program will focus on the development of measurement and screening tools that could be used to understand the etiology and impact of stigma related to cancer in Low and Middle Income countries (LMICs), including the identification and characterization of cancer stigma as a barrier to preventive and oncology care in LMICs. The program will also support studies to develop interventions in LMICs to reduce cancer-associated stigma. Other areas of interest for both the domestic and global health programs at NCI include: stigma associated with palliative care/pain management, addressing stigmas associated with psychological/ psychiatric outcomes in the context of clinical cancer care (e.g., enhancing provider communication skills), motivating behavior change to improve screening and treatment adherence, and determining predictors of cancer-related stigma.

National Human Genome Research Institute (NHGRI)

The National Human Genome Research Institute (NHGRI) encourages research related to the impact of concerns about stigma on participation in genetic or genomic research and testing, including differences in the degree of perceived or feared stigma across communities or groups. Such research may include, but not be limited to, assessing the impact of perceived or feared stigma on decisions about participation in carrier testing, prenatal testing, newborn screening, and predictive testing for adult onset genetic disorders. NHGRI is also interested in research related to how the genetic attribution of disease affects the degree of stigma perceived by patients, health care professionals, and the public, including any resultant differences in patient care, patient behavior or outcomes, or public perceptions about health and disease. NHGRI encourages the development and evaluation of interventions to reduce stigma based on genetic information or misperceptions about genetics at multiple levels, including individual, community, and/or institutional.

National Institute on Deafness and Other Communication Disorders (NIDCD)

The National Institute on Deafness and Other Communication Disorders encourages research focused on how social stigma affects access to and utilization of prevention measures and treatments for disorders of hearing, balance, smell, taste, voice, speech and language. Specific NIDCD research interests include: 1) the role that stigma plays in the reticence of many working age and older individuals with mild to moderate/severe hearing loss to use amplification devices unless their hearing loss progresses to present marked communication handicaps; 2) how stigma and misconceptions that lead to negative attitudes and erroneous assumptions affect the well-being of individuals with communication disorders, such as those with aphasia, stuttering, or high-functioning autism; and 3) understanding and minimizing stigma as a contributor to health disparities affecting vulnerable demographic groups, including those individuals with deafness who use American Sign Language. NIDCD is interested in the development and evaluation of prospective interventions to reduce stigma at the individual and societal level, and improving quality of life for individuals with deafness and other communication disorders.

National Institute of Mental Health (NIMH)

The National Institute of Mental Health encourages two specific areas of research focused on reducing stigma: AIDS-related and suicide prevention-related research. AIDS-related research should focus on how HIV-associated stigma, and stigma associated with being a member of a high-risk group (men who have sex with men, minority women) impact access to and uptake of HIV prevention, care and treatment. Research on the health and economic impact of other forms of HIV-associated discrimination, including the combination of HIV associated stigma/discrimination and racial or ethnic discrimination or other forms of discrimination is also of interest.

Stigma research related to mental disorders and their treatment should test stigma reduction strategies where improvement in symptoms of the disorder (via improved help-seeking, identification and treatment, or adherence) and/or in functioning (e.g. employment) are the primary outcomes. There is particular interest in determining whether decreasing stigma related to suicidality leads to increased help-seeking and referrals for at-risk individuals. (See http://actionallianceforsuicideprevention.org/task-force/research-prioritization).

National Institute of Neurological Disorders and Stroke (NINDS)

Attitudes regarding neurological disorders have become less negative over time, but problems of stigma remain widespread. Often, misinformation and misconceptions lead individuals to have negative attitudes and behaviors toward people with neurological disorders. Stigma, whether felt or overtly experienced, has many negative consequences for both health and quality of life for individuals with a neurological disorder and their families.

The National Institute of Neurological Disorders and Stroke encourages research focused on the development and evaluation of programs that reduce stigma and lead to increased access to care, minimize health disparities, and improve health and quality of life for individuals with neurological disorders across the lifespan.

Section II. Award Information

Funding Instrument	Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.
Application Types Allowed	New Resubmission The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.
Funds Available and Anticipated Number of Awards	The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.
Award Budget	The combined budget for direct costs for the two year project period may not exceed $275,000. No more than $200,000 may be requested in any single year. Applicants may request direct costs in $25,000 modules, up to the total direct costs limitation of $275,000 for the combined two-year award period.
Award Project Period	The total project period may not exceed 2 years.

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made in response to this FOA.

Section III. Eligibility Information

1. Eligible Applicants

Eligible Organizations

Higher Education Institutions

Public/State Controlled Institutions of Higher Education
Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

Hispanic-serving Institutions
Historically Black Colleges and Universities (HBCUs)
Tribally Controlled Colleges and Universities (TCCUs)
Alaska Native and Native Hawaiian Serving Institutions
Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

Small Businesses
For-Profit Organizations (Other than Small Businesses)

Governments

State Governments
County Governments
City or Township Governments
Special District Governments
Indian/Native American Tribal Governments (Federally Recognized)
Indian/Native American Tribal Governments (Other than Federally Recognized)
Eligible Agencies of the Federal Government
U.S. Territory or Possession

Other

Independent School Districts
Public Housing Authorities/Indian Housing Authorities
Native American Tribal Organizations (other than Federally recognized tribal governments)
Faith-based or Community-based Organizations
Regional Organizations
Non-domestic (non-U.S.) Entities (Foreign Institutions)

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement, are allowed.

Required Registrations

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
System for Award Management (SAM) (formerly CCR) Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
NATO Commercial and Government Entity (NCAGE) Code Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
Grants.gov Applicants must have an active DUNS number and SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account and should work with their organizational officials to either create a new account or to affiliate an existing account with the applicant organization’s eRA Commons account. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization 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 support.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

2. Cost Sharing

This FOA does not require cost sharing as defined in the NIH Grants Policy Statement.

3. Additional Information on Eligibility

Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

NIH will not accept any application that is essentially the same as one already reviewed within the past thirty-seven months (as described in the NIH Grants Policy Statement), except for submission:

To an RFA of an application that was submitted previously as an investigator-initiated application but not paid;
Of an investigator-initiated application that was originally submitted to an RFA but not paid; or
Of an application with a changed grant activity code.

Section IV. Application and Submission Information

1. Requesting an Application Package

Applicants must download the SF424 (R&R) application package associated with this funding opportunity using the Apply for Grant Electronically button in this FOA or following the directions provided at Grants.gov.

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

For information on Application Submission and Receipt, visit Frequently Asked Questions Application Guide, Electronic Submission of Grant Applications.

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

Required and Optional Components

The forms package associated with this FOA includes all applicable components, required and optional. Please note that some components marked optional in the application package are required for submission of applications for this FOA. Follow all instructions in the SF424 (R&R) Application Guide to ensure you complete all appropriate optional components.

SF424(R&R) Cover