Full Text PA-93-47

PREVENTING ALCOHOL-RELATED PROBLEMS AMONG ETHNIC MINORITIES

NIH GUIDE, Volume 22, Number 5, February 5, 1993

PA NUMBER:  PA-93-47

P.T. 34, FF

Keywords: 
  Alcohol/Alcoholism 
  Social Psychology 
  Risk Factors/Analysis 


National Institute on Alcohol Abuse and Alcoholism

PURPOSE

The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
invites researchers to submit research grant applications related to
the prevention of alcohol-related problems among ethnic minority
groups of African Americans, Americans, Asian Americans, and Pacific
Islanders.  Most of these groups are at elevated risk for specific
alcohol problems or may have changing patterns of increased alcohol
consumption.  All of these minority groups require the development
and evaluation of culturally relevant programs of alcohol abuse
prevention.  NIAAA promotes innovative prevention research within a
broad range of populations and is particularly interested in
receiving  methodologically sound and conceptually grounded
outcome-oriented research applications.

The primary objective of this program announcement is to expand the
limited information available about the prevention of alcohol-related
problems among ethnic minorities .  While differential rates of
alcohol problems have been well documented within minority
communities, the link between ethnic identity and successful alcohol
abuse prevention interventions has not.  Research proposed within the
domain of this program announcement should address factors that
facilitate or impede the development, implementation, and evaluation
of prevention strategies among diverse sociocultural populations.
Attention should be focused on (1) the culturally-appropriate
development or adaptation of interventions within these minority
settings and (2) how ethnic minority identity relates to prevention
research outcomes.  In general, the impact of ethnicity on alcohol
use and prevention of its abuse should be studied within a particular
context, such as, alcohol availability control, server training,
price increases, media messages, or psychosocial antecedents of
high-risk behavior.

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 Program
Announcement, Preventing Alcohol-Related Problems Among Ethnic
Minorities, is related to the priority area of alcohol abuse
reduction.  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).

ELIGIBILITY

Applications may be submitted by domestic and foreign public and
private non-profit and for-profit organizations, such as,
universities, colleges, hospitals, research institutes and
organizations, units of State and local governments, and eligible
agencies of the Federal government.  Women and minority investigators
are encouraged to apply.  Foreign applicants are not eligible for
First Independent Research Support and Transition (FIRST) awards
(R29).

MECHANISMS OF SUPPORT

Research support may be obtained through applications for a regular
research grant (R01), small grant (R03), or FIRST award (R29).
Applicants for R01s may request support for up to five years.  The
average direct cost per year for R01s is approximately $220,000.
Small Grants are limited to two years for up to $50,000 per year for
direct costs.  FIRST award applications must be for five years.
Total direct costs for the five-year period may not exceed $350,000
or $100,000 in any one budget period.  FIRST awards and small grants
cannot be renewed, but grantees may apply for R01 support to continue
research on the same topics.

Annual continuation awards will be made subject to continued
availability of funds and progress achieved.

RESEARCH OBJECTIVES

Background Information on Alcohol-Related Problems and Use Among
Ethnic Minorities

In the United States, alcohol use is involved in nearly 100,000
deaths annually, including approximately one-half of the nearly
45,000 fatalities in traffic crashes; 27,000 deaths due to cirrhosis
of the liver; and a high proportion of the deaths due to homicide,
suicide, drowning, falls, burns, and other accidents.  Alcohol abuse
results in alcohol-related injuries and violence, marital discord,
job loss, and serious medical consequences including birth defects.
Alcohol-related problems and costs are unevenly distributed across
racial and ethnic groups this uneven distribution may be related to
cultural differences in drinking patterns.  Surveys have found
disproportionately high levels of alcohol consumption and
alcohol-related problems among African Americans, Hispanic Americans,
and Native Americans.  In contrast, Asian Americans and Pacific
Islanders have been found to have lower levels of alcohol use.
However, recent evidence indicates that consumption may be increasing
among these two groups.

African Americans

Alcohol-related Problems: African Americans comprise the largest
ethnic minority in the United States, accounting for 12 percent of
the total population.  Results of a 1983 national study of drinking
problems and patterns found that African Americans, especially males,
are at high risk for acute and chronic alcohol-related diseases; such
as, cirrhosis, alcoholic fatty liver, hepatitis, heart disease, and
cancers of the mouth, larynx, tongue, esophagus, and lung.  High
rates of problem drinking and alcoholism in high-density, urban
African American communities have been associated with assaults,
homicides, accidents, trouble with the law, and family problems.
Several studies have concluded that African Americans are at greater
risk of accidents due to drinking than Caucasians.

Patterns of Consumption:  While overall rates of alcohol consumption
are similar for African American males and Caucasian males, the two
groups differ with respect to the age distribution of drinking and
related problems.  Among Caucasian males, frequent heavy drinking is
most prevalent between 18 and 29 years of age; among African American
males in that age group, heavy drinking is less frequent.  Between 30
and 39, the rates of heavy consumption continue to be high for
Caucasian males; however those of African American males rise
sharply, surpassing those of Caucasians.  Rates of heavy consumption
gradually decrease for men of both races after 40.  Racial
differences in consumption patterns are even more pronounced among
women, but in the opposite direction:  i.e., African American women
tend to drink less.  Nearly half of African American women were found
to be abstainers, compared with one-third of Caucasian women.  A
smaller proportion of African American women than Caucasian women are
heavy drinkers.  African American women in the 18-29 age group are
significantly less likely to drink at all or to drink heavily than
are Caucasian women.

Prevention Research:  An intensive search of the prevention research
literature identified a number of primary and secondary prevention
efforts focused on alcohol-related problems in the African American
population of the United States, but none reported a systematic
evaluation of program effects.  Among the 130 demonstration projects
initiated by the Office for Substance Abuse Prevention (OSAP) in
1987, 24 focus on African American high-risk youth and their
families. Comparisons between the different minority-based
demonstration projects have not been extensively reported.

Studies of African Americans might focus fruitfully on men who are
moderate drinkers, since African Americans are experiencing higher
rates of alcohol-related problems than Caucasians with similar levels
of consumption, for reasons that are not clearly understood.  The
increase in heavy drinking and alcohol-related problems among African
Americans and Hispanics during their 30s suggests the need for
interventions with this age group.

Hispanic Americans

Alcohol-related Problems:  The growing Hispanic population consists
of several distinct groups (Mexican Americans, Puerto Ricans, Cuban
Americans, and persons from other countries of Central America, South
America, and the Caribbean).  These groups now comprise nine percent
of the U.S. population.  Hispanic males suffer disproportionately
from alcohol dependence and problems related to alcohol abuse
compared with African American and Caucasian males in the United
States.  Several studies suggest that Mexican American men drink more
and are more likely to have alcohol-related problems than men in
other major Hispanic subgroups.  In contrast, Hispanic women are at
lower risk for alcohol dependency and alcohol-related problems than
are Caucasian women in the U.S. population.  Nevertheless, the
proportion who drink and have alcohol problems has been rising among
second and third generation Hispanic women, as has the proportion
experiencing related family problems.

Patterns of Consumption:  Several epidemiological studies have found
that alcohol-use patterns among Hispanics differ somewhat from
Caucasians.  Specifically, Hispanic males drink less frequently but
consume larger amounts, have more instances of very heavy or binge
drinking, and have more instances of alcohol-related problems that
continue throughout adulthood than Caucasian males.  Hispanic females
abstain or drink infrequently, usually in a family context.
Consumption rates among Mexican American females are somewhat higher
than those of females in other Hispanic groups.

Hispanic drinking patterns are related to degree of acculturation,
although the relationship differs by gender and nationality group.
Male immigrants appear to quickly adopt a drinking pattern that
blends the high frequency characteristic of U.S. male drinking with
the Hispanic high quantity-per-occasion practice.  Among Hispanic
females, acculturation is associated with increases in both the
proportion of women who drink and the amount they consume.  In
contrast to the men, however, this change in drinking patterns
usually occurs in the first generation born in the United States
rather than in the immigrant generation.

Prevention Research:  A comprehensive review of alcohol prevention
programs targeted at Hispanic populations found that only one of
these (the Ganadores "Winners" project) was systematically evaluated.
The interventions implemented in that program included mass media
messages and community-based activities designed to increase
awareness of the dangers of alcohol and to change attitudes toward
alcohol use and drinking behavior.  The community activities included
dissemination of educational materials and oral presentations by
community leaders designed to make people think more about their own
drinking.  The program resulted in an increase in reported awareness
and knowledge of the dangers of alcohol, but it did not change
drinking behavior.  Nine other current projects aimed at alcohol
prevention among Mexican Americans have been recently described but
have not been evaluated.

Several aspects of the Mexican American culture may have implications
for alcohol abuse prevention strategies and research.  For example,
cultural values may affect the identification of heavy drinking and
the recognition of alcohol abuse as a health problem.  There is a
need to address the role of cultural values as contributors to (and
potential moderators of) problematic drinking practices.  In
addition, interventions designed to increase awareness of the
seriousness of alcohol problems should be tested.  Where appropriate,
research on alcohol use and abuse by Hispanics should also examine
changes in immigrants' attitudes toward drinking.

Native Americans

Alcohol-related Problems:  The Native American population consists of
approximately two millon people and over 300 distinct tribal and
ethnic groupings within the continental United States and Alaska.  It
is a young, diverse, rapidly growing population living in urban,
rural, and reservation settings.  Data for 1978-1980 and 1983-1985,
indicate that alcohol abuse is a contributing factor in 4 of the 10
leading causes of death for Native Americans:  accidents, chronic
liver disease and cirrhosis, homicide, and suicide. Accidents are
still among the leading causes of death for Native Americans.  An
estimated seventy five percent of all traumatic deaths and suicides
among Native Americans are alcohol-related.  Deaths from
alcohol-related causes are particularly prevalent in the 25 to 44 age
group.  Many tribes, particularly in the West, have dramatically
higher accident mortality rates than the national average.  Fatal
accidents among Native Americans are 2.2 to 2.3 times the national
average.

Patterns of Consumption:  Alcohol use varies tremendously from tribe
to tribe.  Some tribes have a smaller proportion of drinking adults
than the U.S. population, while others have more drinkers.
Differences in drinking patterns may also relate to reservation and
urban settings.  The majority of Native American youth report
experimentation with alcohol.  Drinking among Native American youth
is especially serious since mortality from alcohol-related causes is
most common in younger years.  Heavy recreational and binge drinking
may account for unusually high rates of alcohol-related arrests and
accidental deaths among young Native American males.  In general,
Native American women drink considerably less than men, but the
prevalence of drinking among women is growing rapidly in some tribes,
which may help account for the increase in the reported incidence of
Fetal Alcohol Syndrome (FAS).

Prevention Research:  Most primary prevention programs aimed at
Native Americans in recent years have been school-based,
youth-oriented programs emphasizing information about the effects and
consequences of alcohol and other substance abuse.  Their specific
effectiveness is largely unknown, as is the effectiveness of
school-based programs in general.  Several programs designed to
provide youth with coping skills, however, have reliably documented
systematic research efforts.  For example, a modest success was
reported for a bicultural skills-enhancement program delivered in
reservation and non-reservation settings in the Pacific Northwest.
At a six-month follow-up, the test group had better knowledge of drug
effects, better interpersonal skills for managing pressures to use
alcohol and other drugs, and lower rates of alcohol, marijuana, and
inhalant use than the control group.

Native American communities also have instituted community-wide
prevention programs using local resources and Federal Government
funds.  A 1986-1987 survey of community programs funded by the Indian
Health Service (IHS) identified a total of 312 communities involved
in community-based alcohol/substance abuse prevention and
intervention programs.  These programs provided a variety of
services, including alcohol and drug education activities designed to
build self-esteem and coping skills, improve decision-making skills,
and promote family bonding and enrichment.  However, no systematic
evaluation of the effects of these programs was reported in the
presentation of survey results.

In 1983, the IHS introduced a program to prevent FAS by providing
Native American communities throughout the country with the
knowledge, skills, and strategies to initiate prevention measures on
their own.  The chief element of the program was the training of
cadres of trainers/advocates in all local communities served by the
IHS to impart FAS information to a variety of audiences.  Evaluation
results showed a significant gain in knowledge and retention over an
extended period of time by the target populations.

Asian Americans and Pacific Islanders

Alcohol-related Problems:  The 7.3 million Asian Americans and
Pacific Islanders now comprise 2.9 percent of the U.S. population.
In the past decade, the size of the Asian/Pacific population has more
than doubled, and its diversity has greatly expanded.  Currently
available data describe low rates of alcohol-related problems among
Asian/Pacific Americans, even among those identified as heavy
drinkers.  This finding has been attributed to ethnic differences in
physiological reactions (i.e., the "flushing response") as well as
sociocultural and environmental factors.  Among the cultural factors
contributing to low rates of alcoholism are norms that permit
drinking, particularly at social functions, but that discourage
drinking to excess, and tight family and community regulation of
alcohol use.  These factors have been combined into a "reciprocity
model" explaining the alcohol consumption of Asians.  It has been
suggested that the growing numbers and heterogeneity of Asian
immigrants, as well as the progressive assimilation of Asian
Americans into American value systems, will lead to increases in
drinking problems among recent Asian immigrants.

Patterns of Consumption:  Studies consistently suggest that Asian
Americans use and abuse alcohol less frequently than non-Asian
individuals.  In one study examining differences in alcohol
consumption among residents of Hawaii, researchers found that Native
Hawaiians and Caucasians reported higher levels of alcohol use than
Chinese Americans, Japanese Americans, and Filipino Americans.  In
several studies focusing on drinking patterns among Asians in the
United States, however, the view of Asian/Pacific Americans as
non-drinkers was questioned.  In an examination of Chinese, Japanese,
Korean, and Filipinos in Los Angeles, variations in drinking patterns
by ethnicity as well as by age and sex were found.  These data
suggest that Asian Americans display diverse drinking styles,
including a relatively high proportion of heavy drinkers among
Japanese and Filipino men.  The same study found that those
Asian/Pacific Americans most likely to drink are men under the age of
45 who have higher social status.  Their attitudes toward alcohol use
were permissive and their friends tolerant of drinking.

Prevention Research:  Low rates of alcohol-related problems have
contributed to the paucity of prevention research targeted at the
various Asian/Pacific subpopulations.  Six of the ongoing Center for
Substance Abuse Prevention demonstration projects, however, are
targeted at Asian/Pacific youth and community groups.

Areas of research interest

Despite the relatively large number of findings describing broad
ethnic differences in drinking behaviors and alcohol-related
problems, the nature of the linkage between ethnic identity and
alcohol use or abuse has not been established.  There are few
theoretical paradigms to guide research into these variations.
However, there is a need to understand the relationships in order to
increase the potential effectiveness of prevention strategies within
communities.  The paucity of rigorous research on the prevention of
alcohol-related problems indicates a need for a variety of prevention
and pre-prevention studies directed specifically to these
populations.

Environmental Prevention Strategies

A systematic program of research that investigates the effectiveness
of environmental prevention strategies in minority settings is needed
to explore interventions that are designed to change the incentives,
opportunities, risks, and expectations that surround drinking.  This
includes examinations of the impact on African American, Hispanic,
Native American, Pacific Islanders, and Asian communities (or
high-risk groups within them) of national, State, or community-wide
policies designed to control alcohol availability and reduce demand
for such products.  Policy changes might be expected to have diverse
effects on minority ethnic populations because of differences in
sociocultural patterns of drinking, as well as differences in the
manner in which such policies are viewed in different communities and
the ways they are enforced.

Availability Control:  Strategies that might be tested in ethnic
minority contexts that attempt to control the physical, social, and
economic availability of alcoholic beverages include: (1)
strengthening and/or enforcing alcohol beverage control (ABC) laws
regulating the hours of operation and the location and number of
outlets for sales of alcoholic beverages; (2) enhancing enforcement
of minimum drinking age laws; (3) implementing server training
programs; and (4) raising taxes on alcoholic beverages.

Examination of Media Messages:  It is widely believed that the mass
media have an important impact on perceptions, attitudes, and beliefs
regarding alcohol although research evidence is equivocal.  There has
been increasing concern in the past decade about whether the alcohol
industry has tailored advertising to specific ethnic communities.
This suggests the need to explore the effects of focused advertising
on the definitions of appropriate drinking behaviors specific to
minority subcultures and to age, sex, and socioeconomic
subpopulations within ethnic groups.  Research is needed on reactions
of ethnic groups to public service messages and fictional television
and radio programming related to alcohol.  Who are the most credible
communicators within various ethnic groups--and which media channels
(print, television, radio) have the most impact?

Institutions:  Within ethnic communities, institutions such as
churches, business groups, schools, and local political bodies may
play important roles in addressing alcohol problems.  Little is known
about whether and in what ways such influence is exerted in ethnic
communities to address alcohol problems.  To what extent have
institutions such as the beverage and hospitality industries
contributed to or deterred prevention efforts through; for example,
server training programs or the sponsorship of cultural and athletic
events?  To what extent have organizations such as Mothers Against
Drunk Driving (MADD) gained support in implementing prevention
programs in minority communities?

Server Training:  Those who are responsible for serving alcohol have
the opportunity to influence individuals' drinking.  Recently, server
training programs have been implemented to teach those who serve
alcohol in bars and restaurants how to moderate patrons' drinking.
The few studies to date suggest that such programs have been
effective in reducing the rate and amount of consumption by patrons
and the probability of patron intoxication.  There is a need to test
these findings among minority populations.

Price Increases:  Econometric studies have suggested that an increase
in the prices of alcoholic beverages would result in decreases in
consumption, alcohol-involved automobile crashes, and rates of
cirrhosis mortality.  Projections based on these studies have
indicated that a tax on beer amounting to 35 percent of the retail
price would halve the number of alcohol-related fatalities among
16-to 20-year-old drivers. Research is needed to determine whether
these relationships and projections also apply to various ethnic
minority groups.

Prevention Strategies Focusing on the Individual

Prevention efforts targeted at individuals, distinct from those that
target changes in the environment, have attempted to change
consumption practices by increasing individual knowledge of alcohol
effects and by altering attitudes about the use of alcohol.  These
efforts usually involve the use of media campaigns and school-based
instructional programs.  Such programs have sometimes produced
desired changes in knowledge and attitudes, but have not been able to
document long-term behavior changes.  School-based programs that
teach youth peer pressure resistance and social competence skills for
avoiding the use of alcohol and other drugs show promise but have
only demonstrated moderate or short-lived effects.  Even this
conditional effectiveness, however, has not been established for
ethnic minority students and calls for further research.

The study of how ethnicity affects individual differences in drinking
behavior may involve the statistical modeling of personality
variables, alcohol use patterns, and prediction of prevention
outcomes.  In general, the most effective studies of these
interrelationships are longitudinal and may monitor a wide range of
variables, including income level, availability of alcohol, peer and
adult influences, intention to drink, and other identified risk
factors (low academic achievement, lack of prohibitions, early
alcohol use, low self-esteem, psychopathology, poor family relations,
lack of socialization, other drug use, etc.).  These constructs allow
for a more precise examination of the relationship between ethnicity
and effective prevention outcomes.

Identifying High-Risk Groups:  Within each ethnic minority, it is
important to target some intervention efforts at youth and pregnant
women.  This may call for creative techniques for identifying and
engaging these groups in interventions.  For example, since
school-based programs are the most popular form of intervention,
additional strategies may need to be developed to reach students who
have dropped out of school.  The usefulness of brief questionnaires
in targeting high-risk individuals within these populations should be
evaluated.  Programs to prevent Fetal Alcohol Syndrome might seek to
identify individuals who would participate in a support network to
facilitate abstinence during pregnancy.  Such a network could include
peer counseling, family involvement, and community-wide interventions
(i.e., a comprehensive, multiple system strategy).

Identifying Protective Factors:  Research on alcohol-related problems
tends to focus on identifying stressful events and other factors that
place individuals at high risk.  A promising alternative approach is
to explore coping resources and protective factors that have reduced
alcohol problems among minority individuals, particularly those
exposed to "high-risk" environments.  Protective factors may function
both at the individual level--by influencing personal decisions about
engaging in risk-taking behavior--and at the social level--through
the perception of social support from friends and family and through
family characteristics.

Strategies for Program Development

One possible research strategy involves taking interventions from
programs that have been successfully tested in the general community
and adapting those interventions for use with ethnic minorities.
Programs using the social influence model that have shown positive
outcomes might be adapted for implementation with one or more ethnic
minority groups (such as the Midwestern Prevention Project is
attempting to do).

Another possible research approach is systematic testing of
prevention programs that appear to have been successfully implemented
within ethnic communities but were tested on only a limited scale
and/or not systematically evaluated at all.  Examples of these
include the community-based programs implemented by the Indian Health
Service and various demonstration programs that employ social
learning models and are targeted at high-risk youth.

Similarly, it may be useful to design strategies for increasing
awareness of health-related alcohol problems and understanding of the
relationship between cultural attitudes and the social/physical
environment and alcohol abuse.  It may be necessary to determine how
the target groups define "excessive" or "inappropriate" alcohol use,
before developing educational materials about the prevention of
alcohol-related health problems such as cirrhosis.

Methodological Issues:  Mediating Factors

In the development of grant applications researchers may also choose
to focus on particular cross-cutting issues concerning the design of
ethnically-based programs.  Recent research has focused on the
methodological pitfalls of attempting to distinguish the effects of
ethnicity from other demographic variables such as age, gender, and
socioeconomic status and mediating processes such as acculturation.
These variables may make it difficult to identify the unique
importance of ethnicity in prevention outcomes.  Differences in how
the researcher and the subject define ethnicity may also impact the
interpretation of research results.  Furthermore, variations between
individuals in how they define their cultural origin may mediate the
effects of interventions that rely on culture specific messages.

Immigration and Acculturation:  The differences observed in drinking
patterns of ethnic groups by residence and immigrant cohort suggest
the need for further studies of the factors surrounding urbanization,
immigration, and acculturation as they relate to alcohol use.  To
fully understand acculturation, it is also necessary to consider the
effects of such factors as immigrants' economic status, social
interaction patterns, employment opportunities, and access to
alcoholic beverages as intervening variables in the change process.
Stages of acculturation, heterogeneity of ethnic groups and
individual differences in ethnic identification may confound measures
of acculturation.

Different ethnic groups may also experience different stresses
surrounding their cultural identity.  It is important that these
psychological mediators and stressors be identified and examined.
For example, members of ethnic minorities living in a larger society
are, to varying degrees, bicultural.  Bicultural membership may
produce unique stresses (or provide protective advantages) affecting
alcohol consumption.  Research is needed to address the effect of
biculturality on alcohol consumption.  In particular, the possible
contribution of value conflicts to alcohol-related problems in
different social situations needs to be explored.

Alcohol Consumption Patterns:  There may be special problems
associated with using measures of alcohol consumption formulated for
the dominant majority culture.  For example, the consistency of
consumption, the standard drink equivalents, and the standard time
frame referred to may be less familiar and less relevant to some
ethnic groups. Moreover, the pattern of heavy drinking followed by
periods of abstinence may not be captured by consumption measures
based on regular recall periods, or by those that produce a
volume-based measure.  In general, the validity of standard tests and
measuring instruments may have to be explicitly established for the
relevant ethnic populations.

Peer Group and Cohort Comparisons:  Research is needed to determine
the norms and values prevalent in specific age and generational
cohorts in each of the ethnic minority populations as these norms and
values relate to alcohol use and risk-taking.  Without knowledge of
cultural differences in the development of drinking careers, it is
difficult to select appropriate interventions across different age
groups.  For example, cultural differences in susceptibility to peer
pressure will alter the design of interventions that might impede the
formation of alcohol-using "peer clusters" and encourage the
formation of "peer clusters" that provide sanctions against alcohol
use.  These interventions may be developmentally appropriate at one
age but not another within different cultures.

Cultural Sensitivity, Cultural Competence:  There is widespread
agreement that prevention research on ethnic minorities requires an
acquaintance with the culture of the target group.  Concern with
issues of cultural sensitivity suggests the need to consider, for
example, inclusion of members of target minority groups in the
planning and implementation of research programs or the use of the
language of the target group in communications, data collection, or
administration of standardized measures.  Both cultural sensitivity
and methodological considerations suggest that a clear cooperative
arrangement between community organizations or agencies and
researchers is an essential ingredient for the successful
implementation and evaluation of an intervention strategy.

Methodological Considerations

Studies concerning the prevention of alcohol-related problems among
ethnic minorities must be conceived and executed so as to satisfy the
usual criteria of scientific merit.  Careful attention should be paid
to the specific design requirements for adequate statistical power,
particularly if comparisons between or within ethnic minority groups
are planned. Research designs that require comparison groups should
carefully consider the selection of appropriate control groups, the
possibility of differential influence of psychiatric and other drug
use patterns, and the effects of possible differential attrition at
outcome.

Evaluation of Prevention Interventions:  Prevention research
involving interventions must include comprehensive evaluation
components that are conceptually and procedurally integrated into the
overall research program.  The three areas of evaluation (formative,
procedural-or process, and outcome) provide information relevant to
the interpretation of the research findings.  Evaluation bears
directly upon the verification of the research hypotheses connecting
interventions to outcomes.

Formative evaluation involves community members in the identification
of critical issues that should be researched and in the evaluation of
instruments and procedures for appropriateness to the particular
community.  Procedural evaluation refers to the periodic monitoring
of the implementation of interventions during the course of the
research to assure adherence to protocol and to document what
actually was being done or delivered.  Outcome evaluation is
concerned with determining whether the program achieved its
objectives, i.e., whether the outcomes hypothesized to be caused or
produced by the interventions did in fact occur.  This phase of the
evaluation process requires the specification of a verifiable causal
linkage between the interventions and the events or behaviors whose
encouragement or avoidance is the ultimate target of the
interventions.

Cross-Institute or Center Areas of Interest

Projects may be submitted under this announcement that address issues
in common with other agencies.  For example, the Center for Substance
Abuse Prevention (CSAP), which was an original co-funding agency for
the earlier Request for Applications in this area, may be interested
in funding the intervention component of an NIAAA prevention research
grant responsive to this announcement.  CSAP has initiated many
prevention service demonstration projects focused on high-risk youth
and their families, including prevention projects targeted at ethnic
minority groups.  It is conceivable that an applicant could carry out
the research in the context of a CSAP Community Partnership grant,
High Risk Youth grant or other initiative.  This would have the
benefit of providing a potential applicant with a pool of clients
from an ongoing community intervention.  Preapplication consultation
with the appropriate individual listed below is strongly encouraged.
Applications are considered for acceptance and assigned according to
standing PHS referral guidelines.

STUDY POPULATIONS

NIH POLICY CONCERNING INCLUSION OF WOMEN AND MINORITIES AS SUBJECTS
IN RESEARCH

Applications for grants and cooperative agreements that involve human
subjects are required to include minorities and both genders 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 applies
to all research involving human subjects and human materials and
applies to men and women of all ages.  If one gender and/or minority
group are excluded or are inadequately represented in this research,
particularly in proposed population-based studies, a clear,
compelling rationale for exclusion or inadequate representation
should be provided.  The composition of the proposed study population
must be described in terms of gender and racial/ethnic group together
with a rationale for its choice.  In addition, gender and
racial/ethnic issues should be addressed in developing a research
design or sample size appropriate for the scientific objectives of
the study.

Applications for support of research involving human subjects must
use a study design with minority and/or gender representation (by age
distribution, risk factors, incidence/prevalence, etc.) appropriate
to the scientific objectives of the research.  It is not an automatic
requirement for the study design to provide statistical power to
answer the questions posed for men and women separately; however,
whenever there are scientific reasons to anticipate differences
between men and women, and racial/ethnic groups, with regard to the
hypotheses under investigation, applicants should include an
evaluation of these gender and minority group differences in the
proposed study.  If adequate inclusion of one gender and/or minority
group is impossible or inappropriate with respect to the purpose of
the research because of the health of the subjects, or other reasons
or if in the only study population available, there is a
disproportionate representation of one gender or minority/majority
group, the rationale for the study population must be well explained
and justified.

The NIH funding components will not make awards of grants,
cooperative agreements, or contracts that do not comply with this
policy.  For research awards which are covered by this policy,
awardees will report annually on enrollment of women and men,  and on
the race and ethnicity of subjects.

Protection of Human Subjects

The Department of Health and Human Services (DHHS) has regulations
for the protection of human subjects which include additional
regulations for the protection of children.  A copy of these
regulations (45 CFR 46, Protection of Human Subjects), including
those pertaining specifically to children, are available from the
Office for Protection from Research Risks, National Institutes of
Health, Building 31, Room 5B47, Bethesda, Maryland 20892, telephone
301-496-7041.  Specific questions concerning protection of human
subjects in research may be directed to the staff members listed
under INQUIRIES.

An applicant organization proposing to conduct nonexempt research
involving human subjects must file an Assurance of Compliance with
the Office for Protection from Research Risks (OPRR).  As part of
this assurance, which commits the applicant organization to comply
with the DHHS regulations, the applicant organization must appoint an
institutional review board (IRB) which is required to review and
approve all nonexempt research activities involving human subjects.

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS
398 (rev. 9/91) and will be accepted at the standard application
deadlines as indicated in the application kit.

Application kits are available from most institutional offices of
sponsored research and 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 number and
title of the announcement must be typed in item number 2a on the face
page of the application.

FIRST award applications must include at least three sealed letters
of reference attached to the face page of the original application.
FIRST award applications submitted without the required number of
reference letters will be considered incomplete and will be returned
without review.

The completed original and five permanent, legible copies of the form
PHS 398 must be sent or delivered to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

REVIEW CONSIDERATIONS

The Division of Research Grants, NIH, serves as a central
point for receipt of applications for most discretionary PHS
grant programs.  Applications received under this
announcement will be assigned to an Initial Review Group
(IRG) in accordance with established PHS Referral Guidelines.
The IRG, consisting primarily of non-Federal scientific and
technical experts, will review the applications for
scientific and technical merit.  Notification of the review
recommendations will be sent to the applicant after the
initial review.  Applications will receive a second-level
review by an appropriate national advisory council, whose
review may be based on policy considerations as well as
scientific merit.  Only applications recommended by the
Council may be considered for funding.  Second level review  of small
grants (R03s) is by NIH staff.

REVIEW CRITERIA

Criteria for scientific/technical merit review of applications for
regular research grants (R01) will include:

1.  The overall scientific and technical merit and significance of
the proposed research.

2.  The appropriateness and adequacy of the research design,
including the adequacy of mechanisms for the implementation of any
intervention and the methodology proposed for collection and analysis
of data.

3.  The adequacy of the qualifications and relevant research
experience of the principal investigator and key research personnel.

4.  The availability and adequacy of facilities, general environment
for the conduct of the proposed research, other resources, and any
collaborative arrangements necessary for the research.

5.  The appropriateness of budget estimates for the proposed research
activities.

6.  Where applicable, the adequacy of procedures to protect human
subjects.

7.  Conformance of the application to the NIH policy on inclusion of
women and minorities in study populations.

The review criteria for small grants (R03) and FIRST awards (R29) are
contained in the respective program announcements, available from:

National Clearinghouse for Alcohol and Drug Information (NCADI)
P.O. Box 2345
Rockville, MD  20892
Telephone:  (301) 468-2600 or 1-800-729-6686

AWARD CRITERIA

Applications recommended for approval by the appropriate advisory
council will be considered for funding on the basis of overall
scientific and technical merit of the proposal as determined by peer
review, program needs and balance, and the availability of funds.

Terms and Conditions of Support

Grant funds may be used for expenses clearly related and necessary to
carry out research projects, including both direct costs, which can
be specifically identified with the project, and allowable indirect
costs of the institution.  Research grant support may not be used to
establish, add a component to, or operate a prevention,
rehabilitation, or treatment service program.  Support for
research-related prevention, rehabilitation, or treatment services
and programs may be requested only for costs required by the
research.  These costs must be justified in terms of research
objectives, methods, and designs that promise to yield generalizable
knowledge and/or make a significant contribution to theoretical
concepts.

Grants will be administered in accordance with the PHS Grants Policy
Statement (rev 10/90) which should be available from your office of
sponsored research.

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:

Elsie Taylor or Kendall Bryant, Ph.D.
Prevention Research Branch
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
5600 Fishers Lane, Room 13C-23
Rockville, MD  20857
Telephone:  (301) 443-1677

Inquiries relating to fiscal matters may be directed to:

Elsie Fleming
Grants Management Branch
Office of Planning and Resource Management
National Institute on Alcohol Abuse and Alcoholism
5600 Fishers Lane, Room 16-86
Rockville, MD  20857
Telephone:  (301) 443-4703

Inquires relating to prevention service demonstration projects and
evaluation may be directed to:

Armando Pollack
Special Assistant to the Director of Community Prevention and
Training
Center for Substance Abuse Prevention
Rockwall II Building, 9th floor
5600 Fishers Lane
Rockville MD  20857
Telephone:  (301) 443-0369

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance, No. 93.273.  Awards are made under the authorization of
the Public Health Service, Sections 301 and 405, and administered
under the PHS grants policies and Federal Regulations at Title 42 CFR
Part 52, "Grants for Research Projects," and Title 45 CFR Parts 74
and 92, "Administration of Grants" and 45 CFR Part 46, "Protection of
Human Subjects."  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.  Sections of the Code of Federal
Regulations are available in booklet form from the U.S. Government
Printing Office.

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	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)