Full Text CA-92-09

NATIONAL HISPANIC LEADERSHIP INITIATIVE ON CANCER

NIH GUIDE, Volume 21, Number 10, March 13, 1992

RFA:  CA-92-09

P.T. 34, FD

Keywords: 
  Cancer/Carcinogenesis 
  Risk Factors/Analysis 
  Disease Prevention+ 
  Community/Outreach Programs 
  Disease Control+ 


National Cancer Institute

Letter of Intent Receipt Date:  April 10, 1992
Application Receipt Date:  May 21, 1992

PURPOSE

The Division of Cancer Prevention and Control (DCPC), National Cancer
Institute (NCI), invites cooperative agreement applications from
organizational entities to participate, with the assistance of the NCI,
in establishing a culturally and linguistically credible and
efficacious national community outreach cancer prevention and control
program for Hispanic Americans residing in the United States.  The
program will advance through stages of planning, development,
implementation, and evaluation and consist of cancer awareness
activities aimed at reducing cancer incidence and mortality and
increasing survival rates in targeted Hispanic subgroups.  The benefits
that will accrue from implementation of the objectives of this RFA will
all be applicable to other populations that may reside within the
specified geographical areas of the Hispanic American community.  The
range of outreach activities is not limited to any particular effort of
cancer prevention and control but must be multifaceted and should
include, for example:

o  Mobilization of national, state, and local Hispanic lay and
professional leaders to address cancer issues among Hispanics.

o  Coalition building between and among established Hispanic
health-related organizations, community and religious groups, health
care systems, universities with significant Hispanic student
enrollments (at least 15 percent of total enrollment) and faculty,
private, and public cancer care and research projects.

o  Stimulation of greater cancer control data collection and research.

o  Addressing the various cancer risk behaviors and cancer screening
practices of specific Hispanic subgroups and instituting outreach
activities that promote change for improved cancer incidence,
mortality, and early detection rates among Hispanics.

o  Evaluation of the efficacy and effectiveness of individual outreach
activities, the outreach program as a whole, and their impact on
specific Hispanic communities.

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 request
for applications (RFA), National Hispanic Leadership Initiative on
Cancer, is related to the priority area of cancer. 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 REQUIREMENTS

Applications may be submitted by domestic for-profit and non-profit
organizations having enough Hispanic staff and clients to provide
direction and establish a credible outreach program, either public or
private, such as universities, health-related Hispanic organizations,
community clinics, coalitions of health professionals, consortia of
health providers, or combinations thereof.  Teams of applicants are
eligible.  Among a team of applicants, one institution must be proposed
as the lead institution to serve as the applicant and assume the
responsibility for the conduct of the project.  Awards will not be made
to foreign institutions and domestic organizations may not include
international components.  The Commonwealth of Puerto Rico is
considered a domestic entity.

MECHANISM OF SUPPORT

Support for this program will be through a cooperative agreement (U01).
The cooperative agreement is an assistance mechanism in which NCI
programmatic involvement with the recipient during the performance of
the planned activity is anticipated.  The nature of NCI Program
involvement is described in the "Terms of Cooperation" section.  The
awardee will be responsible for the planning, direction, and execution
of the proposed project and interrelated activities.  Except as
otherwise stated in this RFA, the award will be administered under PHS
grants policy as stated in the Public Health Service Grants Policy
Statement, DHHS Publication No. (OASH) 90-50,000, revised October 1,
1991.

This RFA is a one-time solicitation.  Future unsolicited competing
continuation applications will compete as research project applications
with all other investigator-initiated applications and be reviewed by
the Division of Research Grants (DRG).  If the NCI determines that
there is a sufficient continuing program need, the NCI will invite the
award recipient under this RFA to submit a competitive continuation
cooperative agreement application for review.

FUNDS AVAILABLE

Approximately $1 million in total costs per year for five years will be
committed to fund one award under this RFA.  This funding level is
dependent on the receipt of a sufficient number of applications of high
programmatic merit with credible Hispanic cultural/linguistic
competency.  The total project period for applications submitted in
response to the present RFA may not exceed five years.  The earliest
feasible start date for the initial award will be September 1, 1992.
Although this program is provided for in the financial plans of the
NCI, the award pursuant to this RFA is contingent upon the availability
of funds for this purpose.

RESEARCH OBJECTIVES

Background

In general, there is a lack of national data regarding Hispanic
populations.  Thus, currently available national data are of limited
use for assessing the health status and cancer prevention and treatment
needs of the Hispanic population.  Nonetheless, there is evidence that
Hispanics experience disproportionately high incidence rates of certain
cancers and have difficulty in obtaining adequate health care.  This
situation is compounded by the fact that the income of most Hispanic
families is less than the national average, Hispanics are
underrepresented in the health professions, and many Hispanics lack
health insurance coverage. (1)

The latest NCI statistics, although limited, suggest that for all
cancer sites combined, Hispanic Americans experience an overall lower
cancer incidence rate than other ethnic/racial groups.  However, these
data also show that rates for certain cancers are increasing and appear
to be converging with those of the Anglo population. (2)

National Health Interview Survey (NHIS) data indicate that most cancer
screening procedures continue to be underutilized; that this
underutilization may be largely due to lack of knowledge; and that many
Hispanics, in particular, lack knowledge and information about these
procedures.  NHIS data show marked racial/ethnic differences with
respect to knowing about and using all screening procedures. (3)

Concerning, mammography, NHIS data show that Hispanics (32 percent)
were less than half as likely as whites (12 percent) to have heard of
a mammogram; half (13 percent vs. 8 percent) as likely to have heard of
a breast physical examination; and less than half (21 percent vs. 9
percent) as likely to be aware of breast self-exams (BSEs). (4)

Data on knowledge and use of Pap tests indicate that Hispanics (15
percent) are more than three times as likely as Black Americans (4
percent) and seven times as likely as whites (2 percent) to have never
heard of Pap tests. Hispanics (45 percent) were less likely than either
whites (48 percent) or Black Americans (53 percent) to have had a Pap
test in the past year. (4)

Among men, the 1987 National Health Interview Survey found that 31
percent of Hispanic men had never heard of digital rectal exams as
compared to 19 percent of Anglo men. (4)

NCI SEER data (1973-81/1980-85) show that Hispanic Americans also have
increased incidence rates for cancers of the colon, rectum, and
prostate.  Lung cancer incidence rates in Hispanics have increased an
overall 31 percent compared to 26 percent in Anglos (SEER data
1973-81). (5)

Other data indicate that the incidence and mortality rates for oral
cancer in Puerto Rico are among the highest in the world. (6)

Data from the American Medical Association Council on Scientific
Affairs, and from the 1982-84 Hispanic Health and Nutrition Examination
Survey (HHANES), indicate that a low proportion of Hispanic women had
a physical examination in the year prior to interview.  One analysis of
such data concluded that 2.5 million of the nation's 6.8 million
Hispanic women had not had a cervical cancer screening in the last
three years. (7)

Because of the differences in health status and cancer awareness of
Hispanic Americans, NCI intends to pursue a national initiative that
will mobilize the Nation's Hispanic leadership to stimulate and foster
the necessary changes to reduce/eliminate such differences.

National Hispanic Leadership Initiative on Cancer Long-Term Program
Goals

o  Improve cancer survival rates and reduce cancer mortality rates in
Hispanic communities.

o  Prevent future cancer incidence and mortality rate increases in
Hispanic communities.

o  Address the barriers preventing Hispanics from gaining access to
quality health care and referral to appropriate screening, diagnostic
and therapeutic cancer programs.

The outreach program established under this RFA is to be culturally
competent, ethnically appropriate, and whenever necessary,
language-specific to access and impact any given Hispanic group.
Measurable outreach program results should be sought that consider such
factors as the relationship between cancer incidence or mortality and
increased knowledge of cancer screening procedures, changes in patterns
of behavior and in patterns of health care service utilization, and in
reduction of cultural barriers inherent in current health service
delivery.

Major Objectives

The objectives proposed under this RFA are to: a) systematically
develop a national outreach program to promote and increase cancer
prevention and control activities in Hispanic communities; b) uniformly
access major Hispanic groups: e.g., Mexican Americans, Puerto Ricans,
Cuban Americans and Central/South Americans, and identify key community
lay and professional leaders and grassroots populations to organize and
mobilize regional and local outreach cancer awareness activities; c)
develop synergistic coalitions with a variety of health, religious,
social, medical, academic, and media groups and the specific Hispanic
population which they serve; d) evaluate the efficacy and effectiveness
of the outreach strategies, approaches, methods used, and outcome
measures; and e) to measure impact at the national, regional, and local
levels.

The following suggests operational plan and outreach program
considerations.

Planning and Development

The primary focus is the establishment of an effective Hispanic
outreach program for cancer prevention and control.  This program is
envisioned as progressing through phases of planning, development,
implementation, and evaluation.  Each phase should have realistic
timelines and methodically progress from planning (the first 12 months
of the project) to the end of project evaluation/publication stage.

Operationally, the program is expected to consist of a national
coordinating office with regional coordinating offices located in or
near metropolitan areas with large numbers of Hispanic American
residents: e.g., San Antonio, Miami, Chicago, San Diego, Los Angeles,
and New York City. State-wide and multi-State regional outreach areas
are encouraged.  Respondents to this RFA must demonstrate knowledge of
and current or planned liaison with established health-related Hispanic
organizations such as COSSMHO, NCLR, ICPS, HACU, with academic
institutions having significant Hispanic student enrollments (at least
15 percent of total enrollment) and faculty (critical mass to provide
support), the Hispanic Centers of Excellence, and with public and
private cancer-related service providers and researchers, particularly
the NCI Hispanic Cancer Intervention Research Programs, the Hispanic
Community Clinical Oncology Programs, the Cancer Information Service,
and the Office of Cancer Communications.  In addition, the applicant is
expected to establish Hispanic community-based coalitions, provide for
capacity-building among lay and professional Hispanic Americans to
promote and motivate health promotion and cancer prevention practices
among Hispanics, and establish linkages with health providers including
secondary and tertiary providers and with Hispanic political leaders.

Programmatically, the applicant is expected to define and justify the
geographic areas targeted, provide demographics of each targeted
Hispanic subgroup, document the extent of cancer-related needs of the
targeted group, and enumerate the specific start-up activities proposed
including how, when, and why resources may be shared between regions.
For example, in response to an identified lack of information on cancer
awareness, media campaigns could be launched to build general cancer
awareness and cancer patient education, or, in partnership with the
NHLIC Program Director and the Office of Cancer Communications,
materials specific to a cancer awareness need could be developed and
translated into Spanish.  These media campaign efforts and materials
could be developed cooperatively or shared with other regions.

Programmatic elements should include:

o  Rationales for short and long-term national, regional, and local
outreach activities:  e.g., Public Service Announcements, promotional
"tune-ins" involving local and national Hispanic celebrities, cancer
awareness workshops, and novellas.

o  Preparation and translation into Spanish of materials, programs,
news items, other forms of information dissemination, and

o  Commitments from mainstream health providers and organizations to
adopt outreach activities targeting Hispanic Americans, e.g.,
national/local American Cancer Society chapters and the National
Hispanic Nurses Association.

Program Implementation and Management

The implementation and management of the outreach initiative should be
discussed in consideration of reasonable timelines and the array of
interrelated elements of the program including: 1) the approach,
mechanism, and priorities of start-up activities, including
descriptions of the interaction with the subject population and the
expected interaction between the subject population and the
collaborating health service providers; 2) the potential obstacles and
solutions to personnel recruitment, selection, and training; 3) the
establishment of patterns and channels of communication and interaction
among national, regional, and local entities, policy decision-making
procedures, accurate fiscal and outreach activities tracking; 4) the
activation of process evaluation.  Pertinent to this discussion, the
applicant should:

o  Demonstrate bona fide arrangements for the implementation of the
nation-wide outreach program.

o  Demonstrate experience in structuring formal and informal
collaborative efforts with key individuals and groups proposed in this
initiative.

o  Provide technical assistance, on-site assistance, and consultation
concerning regional structure, and advise on organization and
programmatic issues.

o  Provides specific plans and/or arrangements for in-kind
contributions, volunteerism, and other cost-containment techniques.

o  Demonstrate the ability to maintain a cohesive, collaborative, and
cost-effective outreach program.

Program Evaluation

A key requirement under this RFA will be a detailed description of an
explicit evaluation plan including a description of expected outcome
measures.  Such a plan should include the goals, objectives, and
milestones against which process and outcomes will be monitored and
measured and strategies for how the overall program and individual
regional outreach activities will be evaluated.  In developing this
segment of the application, respondents should take into consideration:
1) the goals of this Initiative, 2) the specific activities planned, 3)
the timelines and procedures for their implementation, 4) the
anticipated outcome measures, 5) the roles to be played by both
providers and recipients, and 6) the conceptual, factual, and practical
channels of communication and mechanisms for operation.  The discussion
should include: 1) the rationale for selection of the subject
population and cancer needs targeted within each group, 2) health care
resources available to each group, 3) known cancer incidence rates for
each group, 4) anticipated cancer screening compliance and 5) other
necessary data essential to assess outcome.

SPECIAL REQUIREMENTS

Terms of Cooperation

The cooperative agreement mechanism involves a partnership between the
recipient of the award and the NCI.  The role of the NCI is to provide
technical assistance and guidance to the Principal Investigator with
respect to NCI policies and guidelines.  The following terms and
conditions pertaining to the scope and nature of the interaction
between the NCI and the awardee institution will be incorporated in the
Notice of Award.  These agreements would be in addition to the
customary programmatic and financial negotiations that occur in the
administration of grants.  The Terms of Cooperation described in this
section are in addition to, and not in lieu of, otherwise applicable
OMB administrative guidelines; DHHS Grant Administration Regulations at
45 CFR 74; other DHHS, PHS, and NIH Grant Administration Policy
Statements and other NCI administrative terms of award.  The Terms of
Cooperation follow:

Responsibilities of the Awardee

Under assistance mechanisms, the NIH identifies general or specific
program areas for support, and the performers define and implement the
specific aims, objectives, and approaches for the awarded project
activities.

1) Coordination Among National and Regional Offices

Established channels of collaboration, communication, and
responsibility among Regional Offices and the awardee (National Office)
are expected.  These channels of communication should include proposed
patterns of interaction between the subject population and
collaborating outreach entities.  Shortly after the award is made, the
Principal Investigator, National Coordinator, Regional Coordinators,
and other key project personnel will meet with the NHLIC Program
Director to review current NCI program guidelines, obtain immediate NCI
technical assistance, review planning, implementation, and evaluation
guidelines and procedures, and to resolve cultural, linguistic, and
other Hispanic-related issues.

2) Project Implementation and Management

The Principal Investigator is to develop, implement, and maintain a
credible Hispanic outreach program capable of capacity-building among
Hispanics of various cultures, ages, and economic status to influence
cancer-risk behavior and increased cancer prevention and control
efforts.  The Principal Investigator is also to define and implement
the specific aims, objectives, and approaches for project activities.
National and Regional Coordinators are to develop functional linkages
with the various mainstream and Hispanic collaboration, coordination,
and coalition entities.  They should discern the need for and develop
culturally competent and language appropriate cancer-related materials
and messages targeting major Hispanic groups.  Additionally, the
applicant must seriously pursue avenues for in-kind contributions,
volunteerism, and other cost-containment techniques.  Further, the
applicant must pursue affiliation with secondary and tertiary health
care providers and facilitate the long-term institutionalization of the
outreach initiative.

3) Meetings

The Principal Investigator must adequately justify the budget for each
12 month segment for a total of five years of support.  This must
include proposed budgets for Regional Offices, justification of line
items such as personnel, consultants, major equipment, and travel.
Four trips to NCI must be projected in the first eighteen months of the
project and up to three trips per year thereafter.  These meetings, to
be attended by the National Coordinator, Principal Investigator,
Regional Coordinators, and one or two key project staff, will be for
the purpose of maintaining project cohesiveness, program and product
standards, and providing technical assistance and other expertise.  The
NHLIC Program Director will attend each meeting and may
approve/disapprove the decisions and consensus reached.  Additional
communications will be by telephone conference call (approximately
monthly).

4) Data Management

The NHLIC Program Director and Principal Investigator will periodically
review program implementation procedures, evaluation methodologies and
approaches, and appropriateness of outreach activities.  National and
Regional Coordinators will be responsible for reconciling record
keeping procedures and evaluation methods, and ensuring comparative
qualitative and quantitative data collection across regional areas.
Assessment of meaningful outcome measures and recommendations for
change will be the joint efforts of the Principal Investigator and the
NHLIC Program Director.  Further, it is anticipated that common
products, activities, and resources will be utilized across regional
areas to maximize cost containment and comparison of findings.

5) Reporting Requirements

In addition to a semi-annual progress report, an annual report of
activities initiated according to the proposed time schedule will be
requested.  These reports must include the status of activities
initiated, any successes or problems, action undertaken to resolve the
problem(s), and data and program findings to date.  Annual reports must
specify activities planned for subsequent years along with projected
initiation and completion dates.

6) Publications

Materials developed for training sessions, media campaigns, community
meetings, promotions, and other reports will be jointly reviewed for
cultural and language appropriateness by the National and Regional
Coordinators and the NHLIC Program Director.  Copies of all materials
developed, publications, and major presentations are to be provided to
the NHLIC Program Director.  Inclusion of the NHLIC Program Director as
a co-author in publications may occur subject to consent by the awardee
if the nature and amount of the contribution of NHLIC Program Director
so warrants.  Acknowledgement of NCI support must be included in
publications and presentations of work done under this RFA.

Responsibilities of NHLIC Program Director

1) Monitoring

There shall be periodic on-site monitoring of the national office and
each regional office by the NHLIC Program Director.  Such visits may
include discussions regarding initiative planning and implementation,
staff recruitment and training, coalition formation, conference
development, and overall evaluation efforts.  These reviews may result
in a recommendation for continuation of support, suspension or
termination of support previously provided, the withholding of support
recommended for future budget periods, or adjustments to recommended
levels of support for future years.

2) Personnel

The NHLIC Program Director may approve/disapprove all key personnel
recruitment, selection, and/or reassignment during the project period
and will recommend areas of expertise necessary to execute and maintain
an efficacious Hispanic outreach program.  Key personnel are the
National Coordinator, Principal Investigator, and Regional
Coordinators.

3) Award Continuation Process

As part of the annual review process, the NHLIC Program Director will
review the status of each outreach activity on the basis of information
obtained from site visits, the semi-annual and annual progress reports,
and the availability of outcome measures to determine if significant
community impact has been achieved to justify continued funding.  As
described under "Monitoring" above, adjustments to support may be made
based on the review. Decisions for continued funding will be based on
overall effectiveness of the initiative and the following criteria:

o  Demonstrated development and implementation of a cohesive and
adequate number of culturally competent and linguistically appropriate
outreach activities;

o  Establishment of linkages with key Hispanic lay, professional, and
scientific community leaders;

o  Establishment of coalitions to empower grassroots Hispanic groups to
advance health promotion and cancer prevention and control efforts;

o  Documented findings based on process and outcome evaluation of
outreach activities; and

o  Maintenance of effective relationships with national Hispanic
health-related organizations, private and public cancer care and cancer
research programs, and academic institutions with significant Hispanic
student enrollments.

Arbitration Procedures

The "Terms of Cooperation" require that the NHLIC Program Director make
decisions concerning continuation of an award based on successful
performance of the awardee institution during the planning and
developmental period of the cooperative agreement.  Disagreements
(e.g., programmatic, technical, and evaluation) arising pursuant to
these approvals will be arbitrated by a panel composed of one award
recipient designee, one NCI designee, and a third designee, with
expertise in the relevant area, chosen by the other two.  These special
arbitration procedures in no way affect the awardee's right to appeal
an adverse action in accordance with PHS regulations at 42 CFR, Part
50, Subpart D and DHHS regulations at 45 CFR, Part 16.

STUDY POPULATIONS

The targeted population intended under this RFA is the approximately 22
million U.S. Hispanic Americans males and females of all ages and
economic status, which include:  Mexican Americans, Puerto Ricans,
Cuban Americans, Central and South Americans, and other Hispanic
groups.  Applicants responding to this RFA are expected to successfully
access major Hispanic subgroups, to significantly increase cancer
awareness and decrease cancer risk behaviors in these populations,
thereby impacting on the cancer incidence rates of these Hispanic
populations.

SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH
POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL
RESEARCH STUDY POPULATIONS

NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical
research grants and cooperative agreements will be required to include
minorities and women in study populations so that research findings can
be of benefit to all persons at risk of the disease, disorder or
condition under study; special emphasis should be placed on the need
for inclusion of minorities and women in studies of diseases, disorders
and conditions which disproportionately affect them.  This policy is
intended to apply to males and females of all ages.  If women or
minorities are excluded or inadequately represented in clinical
research, particularly in proposed population-based studies, a clear
compelling rationale should be provided.

Due to the nature of this solicitation, the inclusion of minorities as
a requirement is satisfied.

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 and sample size appropriate
for the scientific objectives of the study.  This information should be
included in the form PHS 398 in Section 2, 1-4 of the Research Plan AND
summarized in Section 2, E, Human Subjects.

For the purpose of this policy, clinical research includes human
biomedical and behavioral studies of etiology, epidemiology, prevention
(and preventive strategies), diagnosis, or treatment of diseases,
disorders or conditions, including but not limited to clinical trials.

The usual NIH policies concerning research on human subjects also
apply.  Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.  However,
every effort should be made to include human tissues from women and
racial/ethnic minorities when it is important to apply the results of
the study broadly, and this should be addressed by applicants.

If the required information is not contained within the application,
the application will be returned.

Peer reviewers will address specifically whether the research plan in
the application conforms to these policies.  If the representation of
women in a study design is inadequate to answer the scientific
question(s) addressed AND the justification for the selected study
population is inadequate, it will be considered a scientific weakness
or deficiency in the study design and will be reflected in assigning
the priority score to the application.

All applications for clinical research submitted to NIH are required to
address these policies.  NIH funding components will not award grants
or cooperative agreements that do not comply with these policies.

LETTER OF INTENT

Prospective applicants are asked to submit, by April 10, 1992, a letter
of intent that includes a descriptive title of the proposed outreach
program, the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and participating
institutions, and the number and title of the RFA in response to which
the application may be submitted.

Although, the letter of intent is not required, is not binding, and
does not enter into the review of subsequent applications, the
information that it contains is helpful in planning for the review of
applications.  It allows NCI staff to estimate the potential review
workload and to avoid possible conflict of interest in the review.

The letter of intent is to be sent to:

NHLIC Program Director
National Outreach Initiatives Branch
Division of Cancer Prevention and Control
National Cancer Institute
Executive Plaza South, Room 400C
9000 Rockville Pike
Bethesda, MD  20892-4200
Telephone:  (301) 496-8680

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for this cooperative agreement.  These forms are available
at most institutional business offices; from the Office of Grants
Inquiries, Division of Research Grants, National Institutes of Health,
5333 Westbard Ave, Room 449 Bethesda, MD 20892, telephone 301/496-7441;
and from the NIH program administrator named below.

The RFA label available in the PHS 398 application form must be affixed
to the bottom of the face page.  Failure to use this label could result
in delayed processing of the application such that it may not reach the
review committee in time for review.  In addition, the RFA title and
number must be typed on line 2 of the face page of the application form
and check the "YES" box.

Submit a signed, typewritten original of the application, including the
checklist, and three signed, exact photocopies, in one package to:

DIVISION OF RESEARCH GRANTS
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At time of submission, two additional copies of the application must
also be sent to:

Hernon H. Fox, Referral Officer
Division of Extramural Activities
National Cancer Institute
Westwood Building, Room 838
5333 Westbard Avenue
Bethesda, MD  20892

Applications must be received by May 21, 1992.  If an application is
received after that date, it will be returned to the applicant.  Also,
the DRG will not accept any application in response to this
announcement that is essentially the same as one currently pending
initial review, unless the applicant withdraws the pending application.
Nor will the DRG accept any application that is essentially the same as
one already reviewed.  This does not preclude the submission of
substantial revisions of applications already reviewed, but such
applications must include an introduction addressing the previous
critique.

REVIEW CONSIDERATIONS

Review Procedures

Upon receipt, applications will be reviewed by the DRG for
completeness.  Incomplete applications will be returned to the
applicant without further consideration.  Evaluation for responsiveness
to the program requirements and criteria stated in the RFA is an NCI
program staff function.  Applications that are judged non-responsive
will be returned to the applicant but may be submitted as
investigator-initiated research grants at the next receipt date.

Those applications that are competitive and responsive will be
evaluated in accordance with the criteria stated below for technical
merit by an appropriate peer review group convened by the NCI.
Applications may be subjected to triage by an NCI peer review group on
the basis of technical merit relative to other applications received in
response to this RFA.  The review criteria to be used are identified
below.  The NIH will remove from further competition those applications
judged by triage to be noncompetitive for award and notify the
applicant Principal Investigator and the responsible institutional
official.  Those applications judged to be competitive will undergo
further technical merit review.  The second level of review will be
provided by the National Cancer Advisory Board.

Review Criteria

Applicants will be judged on the following criteria:

1) Programmatic, technical, and health significance:

o  Demonstrated cultural competency and linguistic relevance of
proposed national and regional outreach plan(s).

o  Clearly stated goals, objectives, and expected outcome measures
including the comprehensiveness, feasibility, and credibility of the
implementation plan.

o  Adequacy and soundness of the national/regional evaluation plan(s)
including methods and associated documentation and detailed description
of the plan to maintain program cohesiveness, product standards, and
cost containment.

o  Justification for selection of the subject populations, the
geographic regional office settings, and areas targeted for outreach
activities (Bureau of Census "greatest proportion of Hispanics"
settings are expected).

o  Documentation of factors that describe the cancer control needs of
the target population, cancer-related behavior risk factors, and health
care utilization.

2) Appropriateness and adequacy of the strategies and procedures
proposed to carry out the outreach program:

o  Soundness of the overall design of the proposed national/regional
structure including timelines for implementation of short- and
long-term goals and accompanying process evaluation.

o  Documentation of ability to maintain community support to adequately
access major Hispanic subgroups.

o  Appropriateness of procedures for establishing effective and
systematic coalitions and collaborations, establishing patterns and
channels of communication, and mechanisms for decision-making and
conflict resolution.

o  Assurance of ability to design, develop, and execute the necessary
credible and culturally appropriate outreach activities.

o  Soundness of overall process and outcome evaluation plans and the
degree to which valid conclusions of project effectiveness and
replicability may be feasible.

3) Evidence of qualifications, training, and bilingual/bicultural
competency of the Principal Investigator, National Coordinator,
Regional Coordinators and other key staff to render a sound Hispanic
community outreach program.  Pertinent criteria include:

o  Ability to discern cultural competence in written and oral cancer
awareness messages targeted to U.S. Hispanic Americans.

o  Ability to discern and develop language appropriate written and oral
outreach products and messages targeted to U.S. Hispanic Americans.

o  Ability to establish and maintain high quality of professionalism,
expertise, and oral and written communications with diverse health
professionals, lay personnel, and Hispanic grassroots populations.

4) Availability of resources necessary to implement the outreach
program.

o  Adequacy of facilities, availability of in-kind resources, and use
of volunteerism to conduct the proposed outreach activities.

5) Appropriateness of proposed budget and duration in relation to the
proposed initiative.

o  Justification of the proposed budget including line items, proposed
regional budgets, and shared resource.

AWARD CRITERIA

The anticipated date of award is September 30, 1992.  Applications will
compete for funding based on the quality and merit of the proposed
outreach program as determined by peer review.  Additionally,
preference will be given to applicants demonstrating compelling
evidence of ability to adequately access all Hispanic groups targeted
for outreach activities and to those providing plans to target
geographical areas of known high incidence of preventable and
controllable cancers in the targeted Hispanic population, e.g., areas
with high incidence of cervical cancer.

INQUIRIES

Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcomed.

Direct inquiries regarding programmatic issues to:

NHLIC Program Director
National Outreach Initiatives Branch
Division of Cancer Prevention and Control
National Cancer Institute
Executive Plaza South, Room 400C
9000 Rockville Pike
Bethesda, MD  20892-4200
Telephone:  (301) 496-8680

Direct inquiries regarding fiscal matters to:

Eileen Natoli, Team Leader
Grants Administration Branch
National Cancer Institute
Executive Plaza South, Room 243
9000 Rockville Pike
Bethesda, MD  20892-4200
Telephone:  (301) 496-7800 Ext. 56

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No. 93.399, Cancer Control Science Program.  Awards are made under the
authorization of the Public Health Service Act, Title IV, Part A.
(Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and
285) and administered under PHS grants policies and Federal Regulations
42 CFR Part 52 and 45 CFR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.

References

1) Ginzberg E., Access to Health Care for Hispanics, Special
Communications. JAMA January 9, 1991, 265 (2): p. 239.

2) Marcus A.C., Herman-Shipley N.A., Crane L.A., Engstrom J.E. Recent
Trends in Cancer Incidence among U.S. Latinos. Paper presented at the
114th meeting of the American Public Health Association, Las Vegas,
Nevada, 1986.  Jonnson Comprehensive Cancer Center, Division of Cancer
Control, University of California, Los Angeles, April 1988.

3) 1987 National Health Interview Survey.

4) National Cancer Institute Cancer Statistics Review 1973-1986
including a report on the status of cancer control.  NIH Publication
No. 89-2789, May 1989.

5) SEER, Unpublished Data.

6) Cancer in Five Continents, IARC, Volume V, 1978-82.

7) Harlan L.C., et al., American Journal of Public Health 1991;
81:885-91.

.

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