Expired PA-14-034: Reducing Health Disparities Among Minority and Underserved Children (R21)

Part 1. Overview Information

Participating Organization(s)	National Institutes of Health (NIH)
Components of Participating Organizations	National Institute of Nursing Research (NINR) National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institute on Deafness and Other Communication Disorders (NIDCD)
Funding Opportunity Title	Reducing Health Disparities Among Minority and Underserved Children (R21)
Activity Code	R21 Exploratory/Developmental Grant
Announcement Type	Reissue of PA-11-105
Related Notices	January 09, 2017 - This PA has been reissued as PA-17-117. NOT-OD-16-004 - NIH & AHRQ Announce Upcoming Changes to Policies, Instructions and Forms for 2016 Grant Applications (November 18, 2015) NOT-OD-16-006 - Simplification of the Vertebrate Animals Section of NIH Grant Applications and Contract Proposals (November 18, 2015) NOT-OD-16-011 - Implementing Rigor and Transparency in NIH & AHRQ Research Grant Applications (November 18, 2015) June 4, 2014 - Notice NOT-14-074 supersedes instructions in Section III.3 regarding applications that are essentially the same.
Funding Opportunity Announcement (FOA) Number	PA-14-034
Companion Funding Opportunity	PA-14-033, R01 Research Project Grant
Number of Applications	See Section III. 3. Additional Information on Eligibility.
Catalog of Federal Domestic Assistance (CFDA) Number(s)	93.361, 93.273, 93.173
Funding Opportunity Purpose	This initiative encourages research that targets the reduction of health disparities among children. Specific targeted areas of research include biobehavioral studies that incorporate multiple factors that influence child health disparities such as biological (e.g., genetics, cellular, organ systems), lifestyle factors, environmental (e.g., physical and family environments) social (e.g., peers), economic, institutional, and cultural and family influences; studies that target the specific health promotion needs of children with a known health condition and/or disability; and studies that test and evaluate the comparative effectiveness of health promotion interventions conducted in traditional and nontraditional settings.

Key Dates

Posted Date	December 12, 2013
Open Date (Earliest Submission Date)	January 16, 2014
Letter of Intent Due Date(s)	Not Applicable
Application Due Date(s)	Standard dates apply, by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
AIDS Application Due Date(s)	Standard AIDS dates apply, by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.
Scientific Merit Review	Standard dates apply
Advisory Council Review	Standard dates apply
Earliest Start Date	Standard dates apply
Expiration Date	January 8, 2017
Due Dates for E.O. 12372	Not Applicable

Required Application Instructions

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

Table of Contents

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

Part 2. Full Text of Announcement

Section I. Funding Opportunity Description

Purpose

This initiative is designed to stimulate research that targets the reduction of health disparities among children. For purposes of this initiative, "health disparities" applies to children who have limited access to resources and privileges that impact their health. As such, this initiative includes a focus on ethnic and racial minority children and populations of underserved children to include: children from low literacy, rural and low-income populations, geographically isolated children, hearing and visually impaired children, physically or mentally disabled children, children of migrant workers, children from immigrant and refugee families, and language minority children. The NIH defines children as individuals 0-21 years of age. The primary purpose of this initiative, therefore, is to encourage intervention studies targeting one of the aforementioned groups. Rather than a singular approach, interventions using a multilevel approach (individual, health system, community, societal) are encouraged. In addition, basic studies designed to further delineate mechanisms/pathways of disparities that lead to the development of interventions are also encouraged. Specific targeted areas of research include biobehavioral studies that incorporate multiple factors that influence child health disparities such as biological (e.g., genetics, cellular, organ systems), lifestyle factors, environmental (physical and family environments) social (e.g. peers), economic, institutional, and cultural and family influences; studies that target the specific health promotion needs of children with a known illness and/or disability; and studies that test and evaluate the comparative effectiveness of health promotion interventions conducted in traditional and nontraditional settings. Strategic Plans on Reducing Health Disparities are located at:

NINR: http://www.ninr.nih.gov/aboutninr/ninr-mission-and-strategic-plan/keythemes ,

NIAAA: http://www.niaaa.nih.gov/sites/default/files/20092013HealthDisparitiesStrategicPlan.doc

NIDCD: http://www.nidcd.nih.gov/about/plans/2012-2016/Pages/2012-2016-Strategic-Plan-Full.aspx

Background

Chronic diseases, defined as a disease lasting 3 or more months (National Center for Health Statistics, 2013), disproportionately affect racial and ethnic minorities, including individuals from lower socioeconomic classes, women and children, and may affect these individuals' ability to attain and maintain health. Children are especially vulnerable and often have multiple risk factors for poor health. Children represent 24 percent of the 2011 U.S. population and include 53.2% White, 14% African American, 4.7% Asian/Pacific Islander, 23.5% Hispanic, and 0.9% American Indian/Alaskan Native (US Census Bureau, 2011, ChildStats.gov)). Forty-four percent of all children live in low-income families and nearly one in every five live in poor families. Moreover, the population of children is becoming increasingly more ethnically and racially diverse. The Census Bureau indicated that 50.4 percent of our nation's population younger than age 1 were minorities as of July 1, 2011. Uninsured rates are among the highest for these groups,. There are 8 million uninsured U.S. children ( 38.5% White, 16.2% African American, 4.5% Asian/Pacific Islander, 37.1% Hispanic, 1.3% American Indian, and other (multi-racial) 1.6 %are uninsured. It is also recognized that older children, ages 13 through 18 (38.1%), are particularly at risk of being uninsured (Children’s Defense Fund). The association between poverty, health status, race, ethnicity, insurance status, geographic location, and access to good quality health care, or any health care, is well documented. For example, the U.S. infant mortality rate continues to decline by 12% to a rate of 6.05 per 1,000 live births in 2011. Infant mortality remains disproportionally higher for non-Hispanic Blacks (12.4%) than for non-Hispanic white infants (5.3%). Black and Hispanic children are less likely to have access to health care or to receive preventive services including dental care, emotional counseling and diet management; and, poverty and minority race/ethnicity are associated with increased risk for childhood chronic and disabling diseases. As a result, recent studies estimate the prevalence of child and adolescent chronic conditions, requiring ongoing specialized care, to be between 10-20%; experts note that these estimates substantially undercount some prevalent conditions such as obesity and mental health conditions.

Asthma, the leading chronic disorder in childhood, affects 14% or an estimated 7.1 million or 1 in 10 children under 18 years of age. Minority children and children living in poverty have a greater burden from asthma compared with non-Hispanic white not living in poverty; the same children are less likely to receive adequate treatment and are less likely to have family or community support for their asthma management. Hospitalization for asthma is 40-100% more likely for minority children compared to other children. Other chronic diseases are also becoming increasingly common among the nation s children, but particularly so among minority and underserved children.

In 2010, more than one third of children and adolescents were overweight or obese (CDChttp://www.cdc.gov/healthyyouth/obesity/facts.htm). Obesity, a serious health concern for children and adolescents, is another example of the complex issue of health disparities among minority and underserved children. Although childhood obesity has been a longstanding public health problem, recent increases in obesity prevalence rates have raised the level to epidemic proportions among US children. Results from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that 18.4 percent of children and adolescents ages 2-19 years are obese. Among pre-school age children 2-5 years of age, obesity increased from 10.4 to 12.1% between 2007-2008 and 2009-2010 and decreased from 19.6 to 18% among 6-11 year olds. Among adolescents aged 12-19, obesity increased from 18.1 to 18.4% during the same period. Most worrisome, however, is that these increases are more prominent among non-Hispanic black and Hispanic children. Despite recommendations for a healthier diet, recent data show that the usual diet of today's children includes foods high in saturated fat, high in calorie dense foods and drinks, and low in fruit and vegetable consumption. The 2011 Pediatric Nutrition Surveillance System states that 1 of 7 low-income preschool-aged children is obese.

Poor dietary patterns and sedentary behaviors are not only linked to obesity but to the development of a number of serious disabling and life threatening conditions associated with obesity including type II diabetes mellitus, cardiovascular disease, kidney failure, and blindness. In addition, overweight and obese children and adolescents are at risk of becoming overweight adults with problems of coronary artery disease, hypertension, stroke, respiratory problems, gallbladder disease, osteoarthritis, sleep apnea, some forms of cancer, and premature death. It is clear, that U.S. minority and underserved children and families are at risk for facing serious health consequences as well as a number of socioeconomic consequences (e.g., suboptimal school performance, social stigmatization, the potential for decreased productivity across the life course, and high health care costs) as a result of chronic diseases like obesity.

Congenital hearing loss affects two to three infants per 1,000 live births. While nearly 95% of newborns are screened for hearing loss before leaving the hospital, the Center for Disease Control and Prevention reports that half of those who do not pass the screen lack a documented diagnosis, and more than one-third of those with permanent hearing loss did not receive early intervention services. Without early hearing loss intervention, these children often fall behind their peers in language, cognitive, and social-emotional development. Barriers to follow-up include service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps. Access to hearing health care services for young children from low-income families is particularly challenging. Financial problems in procuring hearing aids are also a significant problem for young children. Language minority children are often identified as having a language disability when they do not. Language- and culturally-appropriate measures are needed to avoid over- as well as under-identifying of these children.

The 2011 Institute of Medicine (IOM) Report, Child and Adolescent Health and Health Care Quality suggests that progress in children and adolescent healthcare has improved since the 2010 IOM Report, Children s Health the Nation’s Wealth: Assessing and Improving Child Health. However, continued improvement is required. Recommendations from the 2011 report include childhood morbidity and mortality, chronic disease conditions, preventable common health conditions (especially mental and behavioral health and oral health), functional status, end-of-life conditions, health disparities, and social determinants of health.

Alcohol is the intoxicant most widely used among adolescents in the U.S. Early onset of problematic alcohol use correlates strongly with the development of alcohol dependence later in life. Compared to those who delay until age 21 or later, youth who report beginning to drink at age 15 or younger are 4 times as likely to have a diagnosis of alcohol dependence at some point in their lives. According to national surveys some minority youth begin drinking at a later age and levels of consumption vary by gender and group. For example, rates of alcohol use, binge drinking, and AUDs have been shown to be greater among some American Indian or Alaska Native adolescents, but lower among Asian Americans. Whereas historically Hispanic women were unlikely to use alcohol, this pattern appears to be changing so that some high school girls are drinking at levels similar to their male counterparts. Lower levels of use are reported among African Americans during youth, but their trajectory predicts higher percentages of heavy and problematic use in adulthood, particularly among males. While underage drinking is associated with substantial morbidity and mortality, age-related risk/protective factors and differential consequences throughout adolescence have not been fully explored. Youth residing in rural setting as well as low income, inner city, public housing developments appear to be extremely vulnerable to risk factors associated with alcohol use.

By the year 2060, current census predictions are that racial and ethnic minority groups will comprise the majority of the US population. This demographic is also predicted to change at a more rapid rate in the pediatric population. Thus, there is an urgent need for research studies focused on the elimination or reduction of health disparities among children to thwart potentially significant burdens on individuals, families, the healthcare system, and society as a whole. In for advances to occur in reducing health disparities among minority underserved children and adolescents it must include sensitivity to cultural norms, values and practices.

Research Objectives

Specific research areas of interest for this FOA include, but are not limited to, the following areas:

Studies that incorporate multiple factors (two or more of the following factors) such as: genetic/epigenetic, physiological, social, psychological, economic and demographic, environmental, technological and cultural and family factors believed to influence child health disparities.
Development of sensitive biological and or behavioral markers to predict risk, disease course and progression of disease.
Interventions designed to reduce risk factors and exposures that lead to development of one or more poor health outcomes.
Culturally and developmentally appropriate interventions that promote increased physical activity, fitness, healthier nutrition and food choices or other health enhancing child health behaviors (e.g., asthma control behaviors, cumulative effects of sedentary lifestyle associate with information technology; use of computer information technology/social networking devices).
Studies that employ social media strategies promoting wellness, delayed onset of debilitating disease, and/or disease management.
Energy Balance interventions using a multilevel approach addressing overweight or obesity among minority and underserved children and adolescents.
Studies that employ economic incentives to promote health.
Intervention studies targeting well-child care, preventive care, or developmental (early interventional or rehabilitative) care.
Intervention studies to prevent, delay, treat or manage risk for disease or progression of disease due to altered physiological, behavioral or physical status secondary to complications of pregnancy and or intrauterine exposures.
Interventions that target the specific health promotion needs of children with a known health condition and/or disability.
Development of language- and culturally-appropriate assessment tools for identification of developmental delays in children who are non-English speaking or have English as a second language.
Studies on intervention services for children with hearing loss from minority and low income families, such as access to hearing healthcare services, including hearing aids and habilitation/rehabilitation programs.
Comparing the effectiveness of the different treatments (e.g., assistive listening devices, cochlear implants, habilitation and rehabilitation methods) for hearing loss in children from diverse cultural, language, medical, and developmental backgrounds.
Studies that test and evaluate the comparative effectiveness of health promotion interventions conducted in traditional and nontraditional settings.
Studies that evaluate how gender, health literacy and immigrant status (including legal and visa status) affect children’s health and access to health care.
Studies of socialization, children’s emerging ethnic identity and gender roles and their impact on health behaviors and health outcomes.
Intervention studies that target children’s and parent’s health beliefs, health literacy and the influence of peers and culture on health behaviors, health care utilization and health outcomes.
Culturally sensitive intervention studies targeting patient-provider respect, communication, interactions and trust in relationships, health care utilization, adherence with treatment plans, and health outcomes.
Development of innovative age and culturally appropriate biobehavioral measures/tools to assess risk for less optimal cognitive, behavioral, psychosocial and physical functioning.
Interventions that include technology in biomedical imaging and bioengineering that reduce health disparities, such as low-cost diagnostic imaging and point-of-care technologies.
Interventions to identify and treat children and adolescents from rural, poor or racial/ethnic minority groups at risk for adverse physical and mental health outcomes resulting from alcohol involvement.

NIAAA is particularly interested in the following:

Children with Fetal Alcohol Spectrum Disorders (FASD) resulting from intrauterine alcohol exposure who need healthcare services equipped to provide early diagnosis and intervention.
Underserved children and adolescents already drinking (treatment interventions) or at high risk of initiating drinking.
Screening, brief intervention and referral to treatment (as necessary) of children and adolescents in school, extracurricular, community and primary care settings.

The R21 activity code is intended to encourage new exploratory and developmental research projects. For example, such projects could assess the feasibility of a novel area of investigation or a new experimental system that has the potential to enhance health-related research. Another example could include the unique and innovative use of an existing methodology to explore a new scientific area. These studies may involve considerable risk but may lead to a breakthrough in a particular area, or to the development of novel techniques, agents, methodologies, models, or applications that could have a major impact on a field of biomedical, behavioral, or clinical research. Applications for R21 awards should describe projects distinct from those supported through the traditional R01 activity code. For example, long-term projects, or projects designed to increase knowledge in a well-established area, will not be considered for R21 awards.

Section II. Award Information

Funding Instrument	Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.
Application Types Allowed	New Resubmission The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.
Funds Available and Anticipated Number of Awards	The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.
Award Budget	Direct costs are limited to $275,000 over an R21 two-year period, with no more than $200,000 in direct costs allowed in any single year.
Award Project Period	The total project period may not exceed two years.

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

Section III. Eligibility Information

1. Eligible Applicants

Eligible Organizations

Higher Education Institutions

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

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

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

Nonprofits Other Than Institutions of Higher Education

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

For-Profit Organizations

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

Governments

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

Other

Independent School Districts
Public Housing Authorities/Indian Housing Authorities
Native American Tribal Organizations (other than Federally recognized tribal governments)
Faith-based or Community-based Organizations
Regional Organizations

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement, are not allowed.

Required Registrations

Applicant Organizations

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

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

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

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

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.

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

2. Cost Sharing

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

3. Additional Information on Eligibility

Number of Applications

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

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

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

Section IV. Application and Submission Information

1. Requesting an Application Package

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

2. Content and Form of Application Submission

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

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

Page Limitations

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

Required and Optional Components

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

Instructions for Application Submission

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.

SF424(R&R) Cover