NIH GUIDE, Volume 21, Number 30, August 21, 1992

PA NUMBER:  PA-92-102

P.T. 34


  Sports Medicine 



National Institute of Arthritis and Musculoskeletal and Skin Diseases


The National Institute of Arthritis and Musculoskeletal and Skin

Diseases (NIAMS) invites grant applications to conduct surveillance and

related research projects on sports injury in youth.


The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This Program

Announcement, Research on Surveillance and Related Studies of Sports

Injury in Youth, is related to the priority area of physical activity,

fitness, and unintentional injuries.  Potential applicants may obtain

a copy of "Healthy People 2000" (Full Report:  Stock No.

017-001-00474-0) or "Healthy People 2000" (Summary Report:  Stock No.

017-001-00473-1) through the Superintendent of Documents, Government

Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238).


Applications may be submitted by domestic and foreign, non-profit and

for-profit, public and private organizations, such as universities,

colleges, hospitals, laboratories, units of State and Local

governments, and eligible agencies of the Federal Government.  However,

foreign institutions are not eligible for the First Independent

Research Support and Transition (FIRST) Award (R29) and the career

development awards (K04, K08, K11).  Applications from minority

individuals and women are encouraged.


Support will be offered through research project grants (R01), FIRST

Awards (R29), research fellowship training awards (F32, F33), and

research career development awards (K04, K08, K11).


Sports and exercise activity in youth are critical to developing and

maintaining physical fitness and general well-being.  These fitness

patterns established in youth may provide the basis for a healthy

life-style throughout adult life.  The occurrence of injuries has been

accepted as a natural risk associated with exercise and especially with

sports participation.  Of the estimated 8 million youth participating

in sports at the junior high and high school level, approximately 25

percent incurred some form of injury.  Therefore, the physical and

financial impact is significant.

One means of reducing these injuries is to understand the nature and

risk factors for sports injuries and to seek preventive measures to

reduce the occurrence.  Injury surveillance approaches have led to

important changes in rules and equipment to reduce the rate of injury.

In one case, trampolines, the nature of the sport could not be modified

to improve safety, therefore, the sport has been eliminated.

On April 8-9, 1991, at the Lister Hill Center of the NIH a conference

was held on Sports Injuries in Youth:  Surveillance Strategies.  This

meeting was co-sponsored by the National Advisory Board for Arthritis

and Musculoskeletal and Skin Diseases, NIAMS, and the Centers for

Disease Control.  The purpose of the Conference was to examine the

various factors required to develop and operate a surveillance system.

Successful systems and problem areas were described.  The resulting

information will provide guidance for researchers entering areas of

investigation involving development and utilization of reliable data

bases in the field of scholastic sports injury.  Published proceedings

from the conference are available from the contact person listed below


The epidemiologic definition of surveillance is the dynamic, close, and

continued watchfulness over the distribution and trends of disease

occurrence through systematic collection, tabulation, and analysis of

relevant mortality and morbidity data.  Essential steps in this process

include data collection, entry, processing, analysis, interpretation,

and presentation.  A weakness in any of these procedures may result in

incomplete, inaccurate, improper, or poorly disseminated findings.  One

of the critical elements in analyzing sports surveillance data is the

determination of the rate (incidence/number of persons at risk) of

injury.  For example, all players on a basketball team may not be at

equal risk, since some may not even enter the game.  Issues such as

these are well defined in the conference proceedings.

The suggested areas for future research that were developed during the

conference were defined in the proceedings as:

o  Developing surveillance systems for consistent national data


o  Developing a national sports injury data base;

o  Injury characterization and intervention schemes;

o  Coordination of data from diverse sources;

o  Developing methods for "small area sampling" of special injury


o  Evaluating re-injury rates and risks;

o  Expanding surveillance to include intramural and extra-scholastic


o  Expanding injury surveillance to include primary grades;

o  Comparing injury rates and conditions to college and professional


o  Considering a wide range of external factors that may add to risks;


o  Developing and evaluating instructional prevention programs.

These areas of research are neither prioritized nor meant to be

restrictive.  Investigators are encouraged to submit applications in

any meritorious area of research responsive to the general research

objectives of this Program Announcement.  In addition to projects that

specifically address surveillance methodology to uncover risks of and

the nature of injuries, the NIAMS will consider to be responsive to

this announcement applications that include biomechanical, biochemical,

or other approaches to elucidating the mechanism of injury.  Such

related studies should either (1) be a component of applications for

surveillance-based research or (2) be based on the findings of other

surveillance data indicating that a particular mechanism may be the

cause of injury.

The project should be founded on a strong hypothesis as evidenced by

preliminary data of the investigator or others.  All data collection

and statistical procedures should be fully defined and justified.





NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical

research grants and cooperative agreements are required to include

minorities and women in study populations so that research findings can

be of benefit to all persons at risk of the disease, disorder or

condition under study.  Special emphasis must be placed on the need for

inclusion of minorities and women in studies of diseases, disorders and

conditions which disproportionately affect them.  This policy is

intended to apply to males and females of all ages.  If women or

minorities are excluded or inadequately represented in clinical

research, particularly in proposed population-based studies, a clear

compelling rationale must be provided.

The composition of the proposed study population must be described in

terms of gender and racial/ethnic group.  In addition, gender and

racial/ethnic issues should be addressed in developing a research

design and sample size appropriate for the scientific objectives of the

study.  This information must be included in Form PHS 398 in Sections

1-4 of the Research Plan and then summarized in Section 5, Human

Subjects.  Applicants are urged to assess carefully the feasibility of

including the broadest possible representation of minority groups.

However, NIH recognizes that it may not be feasible or appropriate in

all research projects to include representation of the full array of

United States racial/ethnic minority populations (i.e., Native

Americans (including American Indians or Alaskan Natives),

Asian/Pacific Islanders, Blacks, and Hispanics).  The rationale for

studies on single minority population groups must be provided.

For the purpose of this policy, clinical research is defined as human

biomedical and behavioral studies of etiology, epidemiology, prevention

(and preventive strategies), diagnosis, or treatment of diseases,

disorders or conditions, including, but not limited to, clinical


The usual NIH policies concerning research on human subjects also

apply.  Basic research or clinical studies in which human tissues

cannot be identified or linked to individuals are excluded.  However,

every effort should be made to include human tissues from women and

racial/ethnic minorities when it is important to apply the results of

the study broadly, and this should be addressed by applicants.

For foreign awards, the policy on inclusion of women applies fully;

since the definition of minority differs in other countries, the

applicant must discuss the relevance of research involving foreign

population groups to the United States' populations, including

minorities.  If the required information is not contained within the

application, the review will be deferred until the information is


Peer reviewers will address specifically whether the research plan in

the application conforms to these policies.  If the representation of

women or minorities in a study design is inadequate to answer the

scientific question(s) addressed and the justification for the selected

study population is inadequate, it will be considered a scientific

weakness or deficiency in the study design and will be reflected in the

priority score assigned to the application.

All applications for clinical research submitted to NIH are required to

address these policies.  NIH funding components will not award grants

or cooperative agreements that do not comply with these policies.


Applications are to be submitted on grant application form PHS 398

(rev. 9/91), except for individual fellowship applications which must

be submitted on form PHS 416-1 (rev. 10/91).  Applications will be

accepted at the standard application deadlines indicated in the

application kits.

Application kits are available at most institutional business offices

and may also be obtained from the Office of Grants Inquiries, Division

of Research Grants, National Institutes of Health, Westwood Building,

Room 449, Bethesda, MD 20892, telephone 301/496-7441.  The title and

number of the announcement must be typed in Section 2a on the face page

of form PHS 398.

The completed original application and five legible copies of form PHS

398 or two copies of form PHS 416-1 must be sent or delivered to:

Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**


Applications will be assigned on the basis of established Public Health

Service referral guidelines.  Applications will be reviewed for

scientific and technical merit by initial review groups of the Division

of Research Grants, NIH, or by the review group of the appropriate

Institute, Center, or Division (ICD), in accordance with the standard

NIH peer review procedures.  Following scientific-technical review,

applications will receive a second-level review by the appropriate

national advisory council.


Applications will compete for available funds with all other approved

applications assigned to that ICD.  The following criteria will be

considered in the making of funding decisions:

o  Quality of the proposed project as determined by peer review;

o  Availability of funds; and

o  Program balance among research areas of the announcement.


Written and telephone inquiries are encouraged.  The opportunity to

clarify any issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Stephen L. Gordon, Ph.D.

Chief, Musculoskeletal Diseases Branch

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Westwood Building, Room 407

5333 Westbard Avenue

Bethesda, MD  20892

Telephone:  (301) 402-3338

Direct inquiries regarding fiscal matters to:

Ms. G. Carol Clearfield

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Westwood Building, Room 726B

5333 Westbard Avenue

Bethesda, MD  20892

Telephone:  (301) 402-3360


This program is described in the Catalog of Federal Domestic Assistance

No. 93.846, (Arthritis, Musculoskeletal and Skin Disease Research).

Awards will be made under the authority of the Public Health Service

Act, Title III, Section 301 (Public Law 410, 78th Congress, as amended,

42 USC 241) and administered under PHS grants policies and Federal

Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not subject

to the intergovernmental review requirements of Executive Order 12372

or Health Systems Agency review.


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