WOMEN'S HEALTH OVER THE LIFECOURSE: SOCIAL AND BEHAVIORAL ASPECTS NIH GUIDE, Volume 21, Number 34, September 25, 1992 PA NUMBER: PA-92-105 P.T. 34, FF, II Keywords: Health Promotion Behavioral/Social Studies/Service Sociology National Institute on Aging National Institute of Child Health and Human Development National Institute of Mental Health PURPOSE The National Institute on Aging (NIA), the National Institute of Child Health and Human Development (NIDCD), and the National Institute of Mental Health (NIMH) invite qualified researchers to submit applications for research to investigate social and behavioral aspects of women's health during adulthood. Research is needed to understand the natural course and consequence of the aging processes of women (e.g., healthy life expectancy) in a general population of reproductive-aged, middle aged and older women, as well as a wide range of special women's issues (i.e., health related behaviors, family life, role and task demands, psychological well-being, work and productivity) that may be related to health and/or aging. Special emphasis on minority women is an integral part of this solicitation. Differences between men and women in health and illness, mortality and social circumstances, appear across the adult lifecourse. Women constitute about 60 percent of the population aged 65 and over and approximately 70 percent of those 85 and over (Lamphere-Thorpe & Blendon, 1991). While they live longer, women also experience more chronic illness and disability than men, due to higher incidence of nonfatal chronic conditions, such as rheumatoid arthritis, depression, and osteoporosis (Ory and Warner, 1990). More than half of women 75 and over live alone. Of those older women who live alone, they are five times more likely to be living in poverty as compared to men of the same age (Aging America, 1991). There are differences in the circumstances of younger and midlife women from those of older women. Women born in 1940 or later experience later onset of childbearing, fewer children, and complete families sooner than women born 1910-1940. These women experience higher divorce rates and are less likely to have children than women from older cohorts (U.S. Bureau of the Census, 1990). Younger and midlife women may be particularly likely to be balancing competing demands of differing role responsibilities. The lifecourse of women, including the timing of family formation and child-rearing, and aging, is affected by differences in their experiences. Family situations and work patterns, including labor force participation and child-rearing, help shape the character of other experiences of women, including reproduction, menopause and aging. Conversely, the order and timing of lifecourse events, in addition to chronological age, may also determine family situations and work experiences. Women's situations are further influenced by ethnicity and cultural practices, neighborhood environments, living arrangements and socioeconomic status. Health and illness may influence, as well as be influenced by, these aspects of women's lives. This Program Announcement (PA) supplements, but does not replace earlier PAs on related topics (see NIH Guide for Grants and Contracts Vol. 17, No. 18, May 20, 1981: Gender and Aging: Relation To Health and Longevity, and NIH Guide for Grants and Contracts, Vol. 20, No. 36, September 27, 1991: Special Issues in Women's Health Over the Life Cycle). The NIA has a particular interest in supporting research on the health and well-being of middle-aged and older women. Earlier social and behavioral research efforts have included studies of women's health and functioning in mid-life, gender differences in specific chronic conditions (e.g., arthritis), burdens of caregiving, family relationships and widowhood, and women's perceptions and responses to normal aging (e.g., menopause). The NICHD is concerned with the health of women during the reproductive years. The timing and integration of different events such as union formation, marriage, the establishment of households, and childbearing during these years is of interest. Women from different socioeconomic, racial, ethnic, and cultural backgrounds may time events differently or may establish different patterns of integrating work and family roles (Zambrana, 1987). More research is needed to identify how the sociocultural environment and demographic factors such as race, gender and social class shape attitudes, behaviors, and opportunities which then influence the health and functioning of women of reproductive (Ford Foundation, 1991) or older ages. The NIMH supports basic, clinical, and applied services research that examines issues relevant to mental disorders or the mental health of older women. The NIMH is particularly concerned with factors and processes that contribute to mental health and adaptation or that may lead to disorder. This interest includes studies of gender differences in psychological processes that may play a role in mental disorder and interpersonal, family, societal, and cultural processes that may constitute risk or protective factors in relation to mental health outcomes. Research has demonstrated that health and the aging process are responsive to some degree of intervention and control. By identifying factors in the sociocultural environment that either positively or negatively affect reproduction, adult women's health, and the aging process it is possible to design specific interventions that can improve the health and functioning of women and lead to an overall improvement in the quality of life for women over the lifecourse. In line with increasing calls for additional research on traditionally ignored women's health issues (Society for the Advancement of Women's Health Research, 1991; Institute of Medicine, 1991; Ory and Warner, 1990; Rodin and Ickovics, 1990), the NIA, the NICHD and the NIMH are targeting the following areas of social and behavioral aspects of women's health and aging for more in-depth examination: o Improved healthy life expectancy, psychological adjustment, and quality of life o Women's health behaviors, especially in the context of family, work, and community o Labor force participation over the lifespan and its relationship to women's well-being, health, and mortality o Multiple roles, stress, stress buffers (such as social support), and physical, psychological, and social consequences for women o Minorities, special populations and cross-national research This PA encourages two basic types of research: (1) research on women's special life circumstances and health needs and (2) comparative research of women and men at differing points in the lifecourse, examining antecedents and consequences of gender differences in health status, health behaviors, social role, and life circumstances. The nature of a woman's aging experience and her health across the lifecourse is influenced by a variety of factors, therefore, research is also encouraged on ethnic, socioeconomic, and racial differences; changing gender and economic roles; and the special needs of reproductive aged, middle aged, and older women. HEALTHY PEOPLE 2000 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 PA, Women's Health Over the Lifecourse: Social and Behavioral Aspects, is related to the priority areas of age-related objectives for adults and older adults and objectives for special populations, including people in minority groups. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-004730-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications for research grants may be made by public and private, for-profit and non-profit organizations, such as universities, colleges, hospitals, and laboratories. Women and minority investigators, in particular, are encouraged to apply. Foreign institutions are not eligible for all mechanisms. Foreign applicants are advised to contact NIA staff to determine eligibility. MECHANISMS OF SUPPORT Applicants funded under this announcement will be supported through the PHS grant award in accordance with PHS policies applicable to research project grants. All research, career development, and research training mechanisms are applicable. RESEARCH OBJECTIVES Examples of relevant research topics include, but are not limited to, the following: Improved Healthy Life Expectancy, Psychological Adjustment, and Quality of Life o comparisons of healthy life expectancy or mortality rates for men and women, and social and behavioral factors which account for reported differences o determination of the impact of co-morbidities (e.g., heart disease, cancer, arthritis, HIV/AIDS) on Activities of Daily Living (ADLs)/Instrumental Activities of Daily Living (IADLs); how various combinations of diseases/illnesses/injuries affect older women's health and functioning o identification of precursors (i.e., changing health, social, housing and environment factors, and prior lifecourse experiences) to the high rates of poverty among the oldest-old o identification of gender-related factors (i.e., gender-specific tasks and activities) that affect women's coping with physical and/or cognitive problems Women's Health Behaviors o understanding why older women have lower rates of preventive health behaviors than younger women for breast cancer and other conditions to which they are particularly vulnerable o clarification of the role of socioeconomic and demographic factors, health perceptions, social supports, attitudes about health and aging, and current medical practices in health behaviors and attitudes of women o identification of behavioral and social interventions which are effective in motivating women to make greater use of preventive health services across the lifespan o identification and examination of social and behavioral components of biological aging, such as menopause o examination of underlying psychosocial and physiological processes linking health and behavior in women vs. those operating in men Labor Force Participation o studies of the impacts of differences in employment patterns on physical and mental health and quality of life, as well as other outcomes o examination of work patterns of women over the life course and their relation to employment opportunities, income levels and related benefits (e.g., health insurance coverage, private pensions, social security) o studies of the economic, social and health determinants and consequences for women who do not participate in the labor force, participate intermittently, or who retire early vs. late o studies of changing work experience and opportunities in different cohorts of women and the effects on health o examination of women's perceptions of job adequacy and perceived control and their relation to physical and mental health o examination of changes in labor force participation (e.g., voluntary leaves for child rearing, forced unemployment, part-time employment, retirement) and their relation to changes in health outcomes Multiple Roles of Women, Stress, Stress Buffers and Physical, Psychological and Social Consequences For Women o understanding how level of support from spouse or other household members in the presence of multiple roles relates to perceptions of burden and health o studies of community and family services that are designed to prevent or alleviate strain associated with caregiving and/or multiple roles (e.g., work/family demands) o identification of the impact of employment on health in the presence of multiple family roles and women's perceptions of work in relation to these roles o examination of different roles of men and women and how they contribute to gender differences in cognitive functioning, in everyday functioning (e.g., cooking, shopping, and driving), and in the relation between cognitive functioning and everyday functioning o examination of how caregiving responsibilities, marital status (divorce, widowhood, single parenthood, cohabitation), and household structure affect health Minorities, Special Populations and Cross-National Research o examination of how patterns of family structure, immigration and migration, age and sex ratio, and opportunity for employment affect specific populations of minority women at different points in the lifecourse o studies of attitudes toward and the availability, utilization, and quality of health care and other services for women in rural or under-served areas o comparative studies of health care, work, family, and economic policies affecting women in different countries o studies of differences in abilities of particular women at risk (e.g., low income, immigrant) to adapt to multiple roles and identification of other specific needs STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH STUDY POPULATIONS NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical research grants and cooperative agreements will be 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 should 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 minorities and women are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale should be provided. The composition of the proposed study population must be described in terms of gender and race/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 should be included in the form PHS 398 in Sections 1-4 of the Research Plan AND summarized in Section 5, Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, the 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, Hispanics). The rationale for studies on single minority populations groups should be provided. For the purpose of this policy, clinical research includes 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 trials. 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 provided. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of minorities or women 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 assigning the priority score 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. APPLICATION PROCEDURES Researchers considering an application in response to this announcement are strongly encouraged to discuss their project, and the range of grant mechanisms available, with NIA, NICHD, or NIMH staff in advance of formal submission. This can be done either through a telephone conversation or through a brief letter of intent giving the descriptive title of the proposed project and identifying the Principal Investigator and, when known, other key participants. Applicants are to use the research grant application form PHS 398 (rev. 9/91) and PHS 416-1 (rev. 10/91) for Individual Fellowships, available at the applicant's institutional business office and from the Office of Grants Inquiries, Division of Research Grants, National Institutes of Health, Westwood Building, Room 240, Bethesda, MD 20892, telephone: 301-496-7441. Complete item 2a on the face page of the applications indicating that the applications is in response to this announcement and print (next to the checked box) WOMEN'S HEALTH OVER THE LIFECOURSE: SOCIAL AND BEHAVIORAL ASPECTS. The PHS 398 application and five legible copies must be mailed to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** REVIEW CONSIDERATIONS Applications will be assigned to the appropriate group for initial review in accordance with the usual PHS peer review procedures. The review criteria are the traditional considerations underlying scientific merit. Applications will be reviewed for scientific and technical merit by an appropriate initial review group; second-level review will be by the appropriate National Advisory Council. Second-level review of individual fellowship applications will be conducted by the appropriate Institute Executive Group. Applications compete on the basis of scientific merit. AWARD CRITERIA Applications will compete for available funds with all other applications. The following will be considered in making funding decisions: o Quality of the proposed project as determined by peer review o Availability of funds o Program balance among research areas of the announcement INQUIRIES 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: Marcia G. Ory, Ph.D. Behavioral and Social Research Program National Institute on Aging Gateway Building, Room 2C234 Bethesda, MD 20892 Telephone: (301) 496-3136 or Nancy Moss, Ph.D. Demographic and Behavioral Sciences Branch National Institute of Child Health and Human Development 6100 Executive Boulevard, Room 8B13 Bethesda, MD 20892 Telephone: (301) 496-1174 or Mary Ellen Oliveri, Ph.D. Personality and Social Processes Research Branch Division of Basic Brain and Behavioral Sciences National Institute of Mental Health Parklawn Building, Room 11C-10 5600 Fishers Lane Rockville, MD 20857 Telephone: (301) 443-3942 Direct inquiries regarding fiscal matters to: Ms. Linda Whipp Grants and Contracts Management Office National Institute on Aging Gateway Building, Room 2N212 Bethesda, MD 20892 Telephone: (301) 496-1472 or Ms. Melinda B. Nelson Office of Grants and Contracts National Institute of Child Health and Human Development Executive Plaza North, Room 505 6130 Executive Boulevard Bethesda, MD 20892 Telephone: (301) 496-5481 or Mr. Bruce L. Ringler Chief, Grants Management Branch National Institute of Mental Health Parklawn Building, Room 7C-15 5600 Fishers Lane Rockville, MD 20857 Telephone: (301) 443-3065 Other Interests in This Research Area Other PHS institutes and agencies are also interested in research dealing with social and behavioral factors affecting women over the lifecourse, including: The General Clinical Research Centers (GCRC) Program of the National Institutes of Health (NIH) provides inpatient and outpatient research facilities, along with specially trained research nurses, research dietitians and other paraprofessionals to host medical research, including research on behavioral aspects of aging. Additionally, most GCRCs are equipped with computerized data management capabilities, as well as with biostatisticians. Applicants from institutions which have a GCRC funded by the NIH National Center for Research Resources may wish to identify the GCRC as a resource for conducting the proposed research. In such a case, a letter of agreement from either the GCRC program director or Principal Investigator must be included with the application. AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.866. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) 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. REFERENCES Aging America: Trends and Projections. (1991). Prepared by the U.S. Senate Special Committee on Aging, the American Association of Retired Persons, the Federal Council on the Aging, and the U.S. Administration on Aging. The Society for the Advancement of Women's Health Research. Towards a Women's Health Research Agenda: Findings of the Scientific Advisory Meeting. 1991. Ford Foundation. Reproductive Health: A Strategy for the 1990s. New York, NY: 1991. Institute of Medicine. Committee on a National Research Agenda. Extending Life, Enhancing Life: A National Research Agenda on Aging. Washington D.C.: National Academy of Sciences, 1991. Lamphere-Thorpe, Jo-Ann & Robert J. Blendon. Years Gained and Opportunities Lost: Women and Health Care in an Aging America. Project on Women and Population Aging. Southport, Ct.: Southport Institute for Policy Analysis. May, 1991. National Institute on Aging. Research on Older Women: Highlights from the Baltimore Longitudinal Study of Aging. May, 1991. Office of Research on Women's Health. ORWH Research Agenda on Women's Health. Bethesda, MD: National Institutes of Health. March, 1992. Ory, Marcia G. and Huber R. Warner. Eds. GENDER, HEALTH, AND LONGEVITY: MULTIDISCIPLINARY PERSPECTIVES. New York: Springer Publishing Company. 1990. Rodin, Judith and Jeannette R. Ickovics. Review and Research Agenda as We Approach the 21st Century. American Psychologist 45 (9): 1018-1034, 1990. U.S. Bureau of the Census, Current Population Reports, Series P-23, No. 165, Work and Family Patterns of American Women. U.S. Government Printing Office, Washington, DC: 1990. Zambrana, Ruth E. A Research Agenda on Issues Affecting Poor and Minority Women: A Model for Understanding Their Health Needs. Women & Health. Winter, 1987:137-160. .
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