Full Text PA-96-018
NIH GUIDE, Volume 25, Number 2, February 2, 1996
PA NUMBER:  PA-96-018
P.T. 34, FF, II

  Drugs/Drug Abuse 
  Disease Prevention+ 
  Risk Factors/Analysis 

National Institute on Drug Abuse
The purpose of this program announcement (PA) is to advance research
to develop, refine, and test the efficacy and effectiveness of
theory-based, universal, selective, and indicated drug abuse
prevention interventions for minorities and women.  These
interventions should combine what is known from drug abuse prevention
research with what is known, in particular, about culturally diverse
and/or gender specific experiences.  This scientific research
initiative will seek to identify risk and protective factors that may
be associated with core cultural and/or gender value systems and life
experiences in order to design and test under controlled conditions
comprehensive, theory-based preventive interventions that are
sensitive to cultural and/or gender norms or needs.  It is imperative
that ethnic and/or gender status be treated as an explanatory
variable and not just a descriptive one; that is, there must be a
theoretical basis offered that lends guidance to the intervention
designed and that will allow for discussions of outcomes in a manner
that contributes to a detailed scientific understanding of prevention
theory and program priorities that best meet the unique needs of
minority sub-populations and women.
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,
Drug Abuse Prevention Intervention for Women and Minorities, is
related to the priority area of alcohol and other drugs.  Potential
applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0 or Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-512-1800).
Applications may be submitted by foreign and domestic, for-profit and
non-profit, public and private organizations such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal Government.
Foreign institutions are not eligible for First Independent Research
Support and Transition (FIRST) (R29) awards.  Racial/ethnic minority
individuals, women and persons with disabilities are encouraged to
apply as principal investigators.
This PA will use the National Institutes of Health (NIH) individual
research project grant (R01) and FIRST (R29) award.  Because the type
and scope of proposed research responsive to this PA may vary, it is
anticipated that the size and period of the award will vary also.
A major priority of the National Institute on Drug Abuse (NIDA) is to
gather and expand the use of scientific information concerning the
prevention of drug abuse and addiction that could lead to HIV
infection and AIDS.  NIDA support of such research rests on a general
assumption that the negative consequences of drug abuse may have
differential impact and may require targeted prevention intervention
strategies for some of the population groups found within the United
States.  Although NIDA encourages research on the extent and nature
of drug abuse among underserved groups, no existing research grant
program addresses the unique risk and protective factors of specific
underserved populations.  Thus, the purpose of this program
announcement is to develop, implement, refine, and test the efficacy
and effectiveness of theory-based, comprehensive drug abuse
prevention intervention models for minority populations and women.
A gestalt position that has been embraced by many is that America is
an umbrella social system where cultures and traditions blend into
one all inclusive community, reflective of common goals,
opportunities and experiences.  While the various racial/ethnic
groups in the United States may share a common culture with many
similarities in areas such as values, spirituality, family
functioning, and language, there are important sociodemographic
differences, (e.g., country of origin, level of education, and
acculturation level) which may explain why a consensus model of
ethnic and cultural melding has remained theoretical and
underdeveloped.  To advance the field of prevention, researchers must
first acknowledge and then accept that groups have retained their own
value, belief, and behavior systems and that the cultural diversity
within these groups has been generally overlooked.
When classifying ethnic minority status, four general population
categories have traditionally been defined as:  (1) Blacks or African
American; (2) Hispanics; (3) Native Americans or American Indians;
(4) Asians or Pacific Islanders.  This simplified division has
produced epidemiologic and etiologic data delineating major
sociodemographic differences across these communities and have
enabled researchers to study each population as if it was an
unvarying, cohesive whole -- a distinct culture. However, nested
within each group are a variety of cultural variations, traditions
and styles that are as distinct and different as constructs measured
across populations.
As such, there is no Black or African American community; there are
individuals who are descendants of American slaves, foreign born
blacks, and individuals that are racially mixed.  The Hispanic group
includes Puerto Ricans, Mexican Americans, Cubans, Central and Latin
Americans, and individuals from Spain.  Likewise, the Native-American
group is not one homogenous community; there are a variety of
Southwestern tribes, Northern Plains tribes, Eastern Woodlands and
Pacific Northwestern groups.  The most complex, and the least
studied, is the Asian and Pacific Islander populations which consists
of individuals from 26 countries/island groups and who have the
fastest growth rate (82 percent) of any group in the 1980s.
Prevention intervention research needs to address diverse culturally
relevant contexts and drug abuse etiologies.   For example,
population studies indicate that American Indians, particularly those
on reservations, have the highest rates of drug abuse compared with
any other minority group.  Is this statistic a commonality across all
American Indians or is it specific to the Southwestern tribes?  What
are the implications for the design and testing of prevention
interventions?  Research focused on the role of acculturation
suggests that Puerto Rican youth who identified less with Puerto
Rican cultural values were more likely to abuse drugs than those who
were more identified.  Is acculturation strain equivocal across
Hispanic groups (e.g., Mexican Americans) and does it impact on
initiation of drug abuse to the same extent?  What prevention
interventions could be developed and tested to address social
adaptation issues?  Data show that African-Americans are more likely
to use drugs intravenously.  Is this pattern consistent for foreign
born as well as American born Blacks?  What are the key factors
promoting IV drug abuse and are these factors amenable to change
through prevention interventions?  Attitudes regarding health and
addiction within the Asian and Pacific Islander groups also vary
greatly.  For example, Samoans do not view drug abuse as an addiction
but, rather, as an episodic mistake in the judgement of the user.
This interpretation of the nature of addiction is incompatible with
the beliefs of other Asian cultures who consider drug abuse as an
imbalance in spiritual matters.  To what extent can prevention
interventions address drug related belief structures that are
indigenous to a culture?  Notwithstanding some shared, basic
underlying cultural similarities across minority groups, their very
real within group differences (e.g., rituals, values, attitudes, etc)
make it critical to fine tune existing prevention intervention
research efforts.
There is a scarcity of prevention intervention research that
addresses the unique set of physical, biological, social and
psychological problems that are specific to women (the term woman is
used to refer to females of all ages.  Elsewhere, where appropriate,
the terms 'girls' and 'adolescent females' are used).  Although
females comprise 51 percent of the population, they have been
neglected in this field of research, and therefore, unserved as a
group distinct from males.  Gender differences in the epidemiology of
drug abuse are quite apparent, with the number of male drug abusers
and addicts exceeding that of females.  The consequences of drug
abuse by women, however, are more severe and data indicate that after
initial use women may proceed more rapidly to drug abuse than men.
The causes, correlates and consequences of drug abuse and addiction
appear also to differ with respect to men and women.  For women, for
example, a fairly high correlation appears to exist between eating
disorder and substance abuse.  Preliminary data from NIDA research
indicates that the more severely a woman diets and engages in binge
eating the more likely she is to experience negative consequences
from drinking alcohol, and the more likely she is to meet the
criteria for substance abuse or dependence.
Women's initiation into drug use also differs from that of men's.
Preliminary results from a study on gender differences in cocaine
initiation and abuse indicate that approximately 90 percent of women
reported that men played some role in their involvement with crack
cocaine.  By contrast, only 17 percent of men reported that women
were involved in their initiating or maintaining the use of crack
cocaine.  Women were more likely to begin or maintain cocaine use in
order to develop more intimate relationships, while men were more
likely to use the drug with male friends and in relation to the drug
trade.  With regard to antecedent conditions, while conduct disorders
and other observable behaviors signal risk for males, the etiology of
female drug abuse appears to lie in predisposing psychiatric
disorders prior to abusing drugs.  Preliminary data from studies of
antecedents of crack cocaine abuse among African American women found
preexisting psychiatric problems to be a major cofactor.
Specifically, there was a strong correlation between the age of first
drug use and the first depressive episode.  Additionally, these women
had conflicting relationships with, and less attachment to, their
Women who have been victims of crime, likewise, appear to have
increased vulnerability to substance abuse.  Research conducted among
a population of women in residential or outpatient drug treatment
programs found that 80 percent had been crime victims.  Additionally,
female crime victims were more likely to have major drug and alcohol
problems than nonvictims.  Female crime victims who suffered from
Post Traumatic Stress Disorder (PTSD) were almost 10 times more
likely to have major alcohol problems and 17 times more likely to
have major drug abuse problems than nonvictims.  Numerous studies
have shown PTSD to be a strong predictor of substance abuse.
Many questions remain to be addressed regarding prevention
intervention activities for females.  For example, to what extent
does initiation of drug use and progression from use to abuse and
dependence differ for females when compared to males?  To what degree
this occurs, will provide important information which needs to be
incorporated in targeted drug prevention intervention efforts.
Different types of 'victimization' (e.g., sexual abuse, physical
abuse, being the daughter of a drug abusing mother and/or father,
etc.) create different patterns of subsequent drug abuse.  How should
prevention interventions differ as a function of this?  Does the
descent from various ethnic cultures promote specific native gender
roles and to what extent are these congruent, complementary, or in
conflict with society, at large?  The scientific answers to these and
many other questions are necessary to advance prevention intervention
Research Goals and Issues
NIDA encourages research applications that test the efficacy and
effectiveness of theory-based preventive interventions at the
universal, selective, and indicated level.  NIDA will also commit to
investigating the relationship between the intrapersonal,
interpersonal, familial, cultural community roles, and other larger
societal factors upon the prevention of drug abuse among minorities
and other underserved populations.  This scientific research
initiative seeks to identify risk and protective factors in order to
design and test comprehensive, theory based preventive interventions
that are sensitive to cultural norms and responsive to community
needs.  Prevention intervention research should focus upon the
strengths of cultural systems as experienced and promulgated by the
family and community.  For example, research is needed to know how
positive family sanctions and strong religious values may protect
culturally diverse youth from drugs of abuse during their early
school years.  Prevention intervention research is needed to know how
family values and community networks of friends, volunteers, and
relatives interact.  Research is needed to design and test promising
drug prevention programs that build upon the cultural, social,
family, and religious values that appear to protect or inoculate many
culturally diverse youth from drug abuse and HIV/AIDS. Prevention
intervention strategies for these groups should entail a
comprehensive approach to their needs at the Universal, Selective and
Indicated levels.
Specifically, Universal prevention interventions are targeted to the
general public or a whole population group that has not been
identified on the basis of individual risk or resilience status.
Selective prevention interventions are targeted to individuals or a
subgroup of the population with well defined risk factors within
their life profiles and whose risk to resilience status to developing
substance abuse disorders is significantly higher than average.
Indicated preventive interventions are targeted to individuals or
subgroups who are identified as having minimal but detectable signs
or symptoms foreshadowing drug abuse, dependence, and addiction, or
with biological markers indicating predisposition for substance use
disorders AND who have not met diagnostic levels according to
For strategies to be potentially effective and interpretable, they
must be guided by theory, take advantage of the cumulative progress
in the field, and must target ethnic minority youth and young adults
and/or women.  How mechanisms of predisposition and/or protection are
affected by intervention and how this is linked to outcome needs to
be explored.  Investigators should pay careful attention to
operationalizing definitions and defining the independent variable
that describe the intervention processes.  Especially encouraged is
research that investigates resiliency and other protective factors
among underserved populations and women who may otherwise be at risk
of abusing drugs but do not.  Studies that aid in the development of
methodologies which can lead to the early identification of those at
risk for drug abuse and HIV/AIDS among the various ethnic/racial
groups and females are particularly encouraged.
All applicants are urged to address issues of project feasibility and
collaborative arrangements at the community level.  The research
proposal should include a randomized or well-controlled
quasi-experimental study design, as well as state of the art sampling
procedures, instrumentation and measurement, data collection, quality
control, client tracking and follow-up, and data analysis.  It is
essential that applicants discuss potential barriers to implementing
this type of study as well as strategies to deal with relevant
issues.  Particularly critical to discuss are issues related to
community collaboration, confidentiality, anticipated staff, and
further types of sub-studies.  Power analyses must be included to
support proposed cell sizes of the research design and overall number
of study participants.  Tests to determine the potential effects of
differential attrition should be included.  Finally, state of the art
econometric techniques for measuring the cost-benefit or
cost-effectiveness of prevention interventions should be included in
the proposed research.
NIDA will accept prevention intervention research applications that:
o  Demonstrates knowledge of the culture, diversity and potential
predispositions to risk behaviors and relevant risk/protective
factors of minority populations and/or women and applies this
knowledge to the proposed prevention research at the conceptual,
design, and analyses level.  Limitations pertaining to the adequacy
to which culture and diversity are addressed should be identified.
o  Demonstrates familiarity with the approaches and problems
associated with working with underserved populations.  Knowledge of
previous prevention intervention research, theories, methods, and
measures is essential. Challenges from a specified problem or
approach must be identified and solutions proposed.
o  Advances theoretical development by incorporating aspects of
culture and risk/protective factors in the conceptual base used for
the proposed prevention intervention(s).
o  Establishes working relationships with minority communities and
o  When appropriate, assessment of gender differences is encouraged.
o  Demonstrates focus on theory-based preventive intervention efforts
that will address salient risk and protective factors specific to
culturally diverse and ethnic minority sub-populations as well as
women.  Addresses questions pertaining to the fit or match of
specific prevention approaches to the diversity of the underserved
population under investigation.  Prevention intervention strategies
may demonstrate differential effects within various ethnic groups and
socioeconomic populations.  Multiple intervention strategies may be
needed to deter and delay the initiation of drug use behavior and to
impede progression to drug dependency and associated social,
psychological, and physiological sequelae.
o  Demonstrates attention to the design and testing of theory- based
prevention programs focused upon the prevention of the precursors to
the drug abuse problem, such as early signs of aggression, violence,
problems with interpersonal relationships, oppositional behavior, and
changing risk factors to abuse that may emerge after drug use has
been initiated.
o  Conducts and rigorously tests culturally sensitive drug abuse
prevention intervention efforts previously developed but not
empirically tested.
o  Proposes a randomized or well-controlled quasi-experimental
research design, a technically sound measurement model that employees
culturally relevant instruments, and advanced statistical procedures
for hypotheses testing.
o  The dual epidemics of drug abuse and HIV infection have
significantly heightened the urgency of developing effective
prevention activities which target HIV risk behaviors.  Drug
abuse-related HIV transmission occurs through the sharing of
contaminated injection equipment and high risk sexual behaviors
(e.g., unprotected sex with multiple partners).  Researchers are
encouarged to specifically address these behaviors in the design and
research of interventions.
It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations) which
have been in effect since 1990. The new policy contains some new
provisions that are substantially different from the 1990 policies.
All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion of Women and Minorities as
Subjects in Clinical Research", which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513), and reprinted
in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume
23, Number 11.
Investigators may obtain copies from these sources or from the
program staff or contact person listed below.  Program staff may also
provide additional relevant information concerning the policy.
Confidentiality.  The PHS has a formal policy concerning Certificates
of Confidentiality and communicable disease reporting.  In brief, the
policy reflects the expectation that research projects will cooperate
with State and local health departments to assure that the purposes
of reporting are accomplished, and the expectation that health
departments will develop relationships with research projects that
assist their mission without thwarting the research goals. A
description of the policy as well as Instructions for Applicants can
be obtained after award.
Applications are to be submitted on the grant application form PHS
398 (rev. 5/95) and will be accepted at the standard receipt dates
indicated in the application kit.  Application kits are available at
most institutional offices of sponsored research and may be obtained
from the Office of Extramural Outreach and Information Resources,
National Institutes of Health, 6701 Rockledge Drive, MSC 7910,
Bethesda, MD 20892-7910, telephone 301-710-0267, email:
girg@drgpo.drg.nih.gov.  The title and number of this PA must be
typed in Item 2 on the face page of the application.
The completed original and five legible copies must be sent or
delivered to:
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC-7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for courier/overnight service)
Applications that are complete will be evaluated for scientific and
technical merit by an appropriate peer review group convened in
accordance with standard NIH peer review procedures.  As part of the
initial merit review, all applications will receive a written
critique and undergo a process in which only those applications
deemed to have the highest scientific merit, generally the top half
of the applications under review, will be discussed, assigned a
priority score, and receive a second level review by the appropriate
national advisory council on board.
Review Criteria
o  scientific or technical significance and originality of the
proposed research;
o  appropriateness and adequacy of the research approach and
methodology proposed to carry out the research;
o  qualifications and research experience of the principal
investigator and staff;
o  availability of resources necessary to the research;
o  appropriateness of the proposed budget and duration in relation to
the proposed research; and
o  adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
The initial review group will also examine the provisions for the
protection of human and animal subjects, and safety of the research
Applicants will compete for available funds with all other approved
applications assigned to the Institute.  The following will be
considered in making funding decisions:  quality of the proposed
project as determined by peer review, availability of funds, and
program priority.
Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.
Direct inquiries regarding programmatic issues to:
Ro Nemeth-Coslett, Ph.D.
Division of Epidemiology and Prevention Research
National Institute on Drug Abuse
5600 Fishers Lane, Room 9A-53
Rockville, MD  20857
Telephone:  (301) 443-1514
Direct inquiries regarding fiscal matters to:
Gary Fleming, J.D., M.A.
Grants Management Branch
National Institute on Drug Abuse
5600 Fishers Lane, Room 8A-54
Rockville, MD  20857
Telephone:  (301) 443-6710
This program is described in the Catalog of Federal Domestic
Assistance No. 93.279.  Awards are authorized under the Public Health
Service Act, Section 301 and administered under PHS policies and
Federal Regulations CFR 52 and 45 CFR Part 74. "Confidentiality of
Alcohol and Drug Abuse Patient Records" may be applicable to these
awards.  Program is not subject to the inter-governmental review
requirements of Executive Order 12372.
The PHS strongly encourages all grant recipients to provide a
smoke-free workplace and promote the non- use of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routine education,
library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.

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