Full Text CA-92-10

NATIONAL BLACK LEADERSHIP INITIATIVE ON CANCER

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

RFA:  CA-92-10

P.T. 34, FC

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 National Cancer Institute (NCI) through the Division of Cancer
Prevention and Control (DCPC), Cancer Control Science Program (CCSP),
National Outreach Initiatives Branch (NOIB), invites cooperative
agreement applications from organizations to participate, with the
assistance of the NCI, in establishing a cancer prevention and control
community outreach program.

This program will involve planning, developing, and implementing cancer
awareness activities with lay and professional Black Americans to
reduce cancer incidence and mortality rates, increase survival rates,
address risk behaviors, and improve screening use and early detection
rates within the U.S. Black American community.  The benefits that will
accrue from implementation of the objectives of this Request for
Applications (RFA) will also be applicable to other indigenous
populations that may reside within the specified geographical areas of
the Black community.  This program will evaluate individual cancer
prevention and control outreach activities as well as the overall
program.  This program should result in measurable improvements such as
knowledge about prevention and early detection of cancer and access and
utilization of diagnostic and treatment services for cancer.

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 RFA,
National Black 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, U.S. Government Printing
Office, Washington, DC 20402-9325 (telephone 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applicants may be domestic for-profit and non-profit organizations,
public and private, such as universities, colleges, hospitals,
laboratories, units of State and local governments, health boards,
public health departments, territorial health departments (including
the District of Columbia), volunteer organizations, clinics,
coalitions, and consortia.  Teams of applicants are encouraged.  Among
a team of applicants, one must be designated as the lead applicant and
assume responsibility for conduct of the project.  Foreign
organizations are not eligible to apply, and applications from domestic
organizations may not include international components.  Women and
minority investigators are encouraged to apply.

MECHANISM OF SUPPORT

Support of this program will be through the cooperative agreement
(U01), an assistance mechanism in which substantial NIH programmatic
involvement with the recipient during performance of the planned
activity is anticipated.  The nature of NCI involvement is described in
the "Terms of Cooperation" section.  The award will be administered in
accordance with PHS grants policy as stated in the Public Health
Service Grants Policy Statement.

This RFA is a one-time solicitation.  Future competitive continuation
applications will compete with all 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
may invite the Awardee to submit a continuation application for review
according to the procedures described in the Review Considerations
section.  The total award period for applications submitted in response
to the present RFA may not exceed five years.

FUNDS AVAILABLE

Approximately $1 million in total costs per year for five years will be
committed to fund one award.  The total award period of this RFA must
not exceed five years.  This level of support is dependent on the
receipt of a sufficient number of applications of high scientific
merit.  Although this program is provided for in the financial plans of
the NCI, the award of a cooperative agreement pursuant to this RFA is
also contingent upon the availability of funds for this purpose.

RESEARCH OBJECTIVES

There are substantial data that show that Black Americans have higher
overall cancer incidence and mortality rates than do whites for all but
3 of 25 primary cancer sites. (2)  Even for certain types of cancers
that occur less frequently in Black Americans, i.e., cancers of the
bladder and corpus uteri, Black Americans have poorer survival rates
compared to whites. (1)  Black Americans have disproportionately larger
numbers of blue-collar workers, possibly increasing the risk of certain
occupationally related cancers. (3) Fewer Black Americans have adequate
health insurance coverage, thereby decreasing the likelihood of access
to early detection methods and state-of-the-art treatment. (3)
Further, certain culturally based factors have been identified and
linked to cancer within the Black American community, such as unhealthy
dietary habits and negative attitudes toward health and health care.

Because cancer prevention and control programs/activities are generally
confronted with culturally based traditions and enormous individual
resistance within minority populations, it is essential that such
impediments be addressed by empowering the Black American community to
act on its own behalf through facilitators who understand and are
sensitive to Black American cultural traditions.

This RFA will support activities involving the determination and
evaluation of the efficacy of existing cancer prevention and control
intervention strategies within the Black American population.  Guided
by the results of the evaluation of these activities, applicants will
propose a strategy for the development and implementation of new NCI
cancer prevention and control interventions that are specific and
culturally sensitive for the U.S. Black American population.

It is envisioned that the scope of the project will encompass several
well-defined geographical regions of the U.S. and will involve three
overlapping phases:  Planning and Development (Phase I), Program
Implementation and Evaluation (Phase II), and Data Analysis and
Reporting (Phase III).  See further details under Other, below.

Background

During the October 1986 meeting of the National Cancer Advisory Board
(NCAB), concern was expressed regarding the targeting of tobacco and
alcohol advertisements to the Black American community inasmuch as
these and similar advertisements would serve to exacerbate the already
disproportionately high rates of cancer among Black Americans.  To
address this issue, the NCAB then established a national planning
committee, comprised of Black American business, education, and health
professionals, to develop an operational plan for increasing community
awareness about cancer.  As a framework for this activity, which was
named the National Black Leadership Initiative on Cancer (NBLIC), six
geographical regions were identified.  During the next year, regional
and community-based hearings were held in six major U.S. cities
(Atlanta, GA; Houston, TX; Los Angeles, CA; Chicago, IL; Washington,
D.C.; and New York, NY), each of which has served since that time as
the operational NBLIC headquarters for its region.  NBLIC operations
were supported and facilitated through an interim arrangement approved
by the NCAB, by means of a supplement to the Minority Consortium Cancer
Center grant.  Subsequently, six Regional Coordinators were appointed,
and the NBLIC concept was implemented as a program activity of the NCI.
Thus, the NBLIC is the first formal outreach initiative of the NCI to
develop a national network of concerned and active leaders to help
address the disproportionately high cancer rates in the Black American
community.

Since its inception, the NBLIC has facilitated a wide variety of
activities to promote cancer control and prevention activities in the
Black American community. Regional Chairpersons, such as Dr. Harold
Freeman and Dr. LaSalle Leffall, past presidents of the American Cancer
Society, have inspired other leaders (lay and professional) in the
Black American community to actively participate in NBLIC sponsored
activities.

The NBLIC has successfully recruited approximately 715 Black American
volunteers who comprise 47 community cancer coalitions nationwide.  An
additional 19 NBLIC coalitions are currently being established.  The
program has developed strong networking relationships with
approximately 200 national, state, local, grassroots, and special
interest organizations across the country and has directly or
indirectly affected the lives of 15-20 million Black Americans.

The NBLIC continues to sponsor major national cancer awareness
campaigns to Black American communities as a means of emphasizing the
importance of early detection and screening.  The campaigns are held
during Prostate Cancer Awareness Week, Breast Cancer Awareness Month,
Minority Cancer Awareness Week, and Cancer Awareness Month.  Free or
low cost mammograms, pap smears, and rectal exams are offered
throughout the year as well as during national cancer campaigns.  The
campaigns encourage Black Americans to make an investment in their
health.

During the first funded year, the primary focus for the program was the
establishment of NBLIC community cancer coalitions.  These coalitions
provide the structure through which the NBLIC facilitates cancer
prevention and control intervention programs.  In the second year, the
Regional Coordinators concentrated on providing technical assistance to
coalition leaders.  The Coordinators and volunteer leaders firmly
established coalitions and defined their role.  Coalitions leaders
received guidance in the areas of volunteer recruitment, demographics
and cancer control needs, assessment, data gathering on cancer
incidence, mortality, and survival, developing cancer resource
information directories, and seeking private sources of support.

The Regional Coordinators promote networking among organizations that
provide cancer and health-related programs to Black Americans and among
cancer survivors. They serve as liaisons between the coalitions and the
various health organizations and serve as primary contacts for
recruiting and accessing local resources.  See Appendix A for
additional examples of NBLIC activities.

Other

Though some technical assistance will be provided by NCI (see Terms of
Cooperation, below), the applicant is responsible for conducting the
activities outlined below in Phases I-III.  The application must,
therefore, address explicitly each of the areas identified.

A.  Phase I:  Planning and Development

The Principal Investigator (PI) of the awardee institution is
responsible for detailed development and fine tuning of the overall
community outreach plan.  Details involving logistical matters and the
hiring of qualified staff are also responsibilities of the PI.

o  The PI must develop a plan for outreach strategies, including an
evaluation design, and identify local organizations and leaders who
would participate in the implementation of dynamic and creative
community outreach activities.

o  The PI must establish effective communication channels that allow
routine exchange of ideas and status reports (financial and
programmatic).  The communication channels must include the PI and key
staff members, Black American leaders and key staff of local Black
American groups, organizations, and coalitions.

o  The PI must identify in-kind contributions to assist with providing
support to coalitions, e.g., office space and additional equipment,
such as voice mail, answering machines, and laptop computers.

o  The PI must describe in detail the proposed organizational structure
under which these activities would be managed.  The applicant must
describe proposed staffing arrangements, and identify key personnel to
be recruited or appointed.  Use of any components of the current
organizational structure is allowed but is not mandatory.  An
indication of the staff of the proposed NBLIC organization and the
Steering Committee must be described.

To assure consistency in overall administrative and programmatic
operations, office procedures, and other organizational areas where
miscommunication and confusion may compromise the effectiveness of the
project, the PI must develop a manual of operations and procedures and
distribute to key staff.

B.  Phase II:  Implementation and Evaluation

The focus during this period is the implementation of the activities
described in Phase I and subsequent evaluation.  The NCI will not
support a project that does not have well-developed and comprehensive
evaluation plans.  The evaluation plan must be conceptually and
procedurally integrated with the overall project.  It must connect
implementation and outcome and specify a time frame for conducting all
evaluation activities.  The evaluation plan must describe the selection
and development of sound measures and instruments for data collection.
The application must include detailed and clearly written descriptions
of process and outcome evaluation.

1.  Process Evaluation

Process evaluation facilitates the replication of effective projects.
It consists of the periodic monitoring of project implementation to
document what actually was being done and to facilitate project
adjustments and corrections when needed over the course of the project.
It involves the collection of both quantitative and qualitative data
that permit a description of the formation and ongoing functions of
community coalitions and the project as a whole.

Process evaluation applications must include descriptions of the
methods proposed to establish, develop, and maintain community
coalitions; the interaction patterns of organizations and individuals
that are included in coalitions (e.g., previously observed patterns of
communication, conflict resolution, coordination, cooperation, and
collaboration); methods proposed to inform and involve the community in
cancer control outreach activities; and efforts planned to assure
community acceptance.  Process evaluation may also include detailed
descriptions of tracking project activities.

2.  Outcome Evaluation

Outcome evaluation consists of assessing the effectiveness of the
project in meeting its goals and objectives.  The design of the outcome
evaluation and the resulting data must be based on measurable goals.
The outcome evaluation design must be rigorous enough to result in
valid conclusions concerning the effectiveness and replicability of the
project.  Baseline data, such as cancer screening trends and rates,
smoking trends and rates, cancer rates, health insurance status,
pertaining to the target area are essential for a meaningful outcome
evaluation.  Proposed baseline data and methods for obtaining such data
must be provided.  Additionally, plans for periodic collection of the
baseline data must be described.  Descriptions of existing services in
the specified area(s) and organizational structures must be provided at
baseline and at each interval.  While researchers should obtain as much
baseline data as possible in the process of preparing the cooperative
agreement application, refinement and development of key elements may
occur at the beginning of the project period.

The NCI will have access to all data generated under this cooperative
agreement and may periodically review the data.  The awardee will
retain custody and primary rights to the data consistent with current
HHS, PHS, and NIH policies.

C.  Phase III:  Data Analysis and Reporting

Although this phase will frequently overlap certain periods of Phase
II, it is anticipated that the activities of Phase III will be most
intense during the last two years of the five-year award.

In conducting the analysis, the PI should consider features of the
setting that may either facilitate or impede implementation of the
project.  The NBLIC Program Director and PI will periodically review
data management procedures and will have access to all data. The
awardee is responsible for selecting members of the Steering Committee.
Data analysts may also be selected by the awardee to prepare reports
from the data collected.

Collaborative publications between the PI and NBLIC Program Director
may occur subject to determination by the awardee. Copies of all
publications and major presentations are to be provided to the NBLIC
Program Director.

SPECIAL REQUIREMENTS

A.  Terms of Cooperation

The cooperative agreement mechanism establishes a partnership between
the awardee and the NCI.  The "Terms of Cooperation" Nature of
Participation of NBLIC Program Director described in this section are
in addition to, and not in lieu of, otherwise applicable OMB
administrative guidelines; HHS grant administration regulations at 45
CFR 75; other HHS, PHS, and NIH grants administration policy
statements; and other NCI administrative Terms of Cooperation.
Generally, the role of the NCI will be to advise, assist, and
facilitate, not direct, NBLIC activities.  The terms of the cooperative
agreement between the grantee and NCI shall remain in effect throughout
the five-year award period.

1.  The NBLIC Program Director shall:

o  Assist the PI to facilitate project/programmatic activities
including principal and ancillary functions during the award period.

o  Serve as a member of the NBLIC Steering Committee and report
annually to the DCPC Board of Scientific Counselors. Meetings with the
Steering Committee shall occur at least three times during the first
year, then twice per year thereafter, to be held in Bethesda, MD.

o  Provide appropriate advice, assistance, and guidance in the design
of activities, the recruitment of staff, and the selection of resource
providers; may approve/disapprove all changes of key personnel
(National Coordinator, Regional Chairpersons, and Regional
Coordinators) during the award period.

o  Develop a schedule for periodic on-site monitoring of each project,
review and evaluate technical performance, and assist in establishing
new priorities.

o  Retain the authority to approve publications and printing costs
exceeding $25,000 for a single publication.

o  Participate in the writing and preparation of publications and
reports, subject to consent by the PI, to assure the consistency of
data acquisition, analysis, and reporting.

o  Communicate regularly via telephone, written correspondence, and
meetings with the PI.

2.  The Awardee shall:

o  Plan, develop, implement, evaluate, and direct all aspects of the
proposed project/programs including principal and ancillary functions
and publish results of the initiative during Phase III.

o  Define the role of the Steering Committee and select members; its
relationship with other committees established during the award period
and how all will interact with the NBLIC Program Director.

o  Provide leadership, technical assistance and materials to regional
offices, coalitions, and organizations to implement cancer prevention
and control awareness programs.

o  Coordinate and monitor all NBLIC activities.

o  Assure participation of all key personnel in planning and bi-annual
meetings.

o  Provide well prepared records and reports in a consistent format to
the NBLIC Program Director and other Steering Committee members
including semi-annual progress and annual status reports.  Other
information may be occasionally requested.

o  Include on all publications, the name, "National Black Leadership
Initiative on Cancer (NBLIC)" and/or the established NBLIC logo and a
by-line (including posters, pamphlets, and similar materials)
identifying the NCI Cooperative Agreement number (e.g., "Supported
under National Cancer Institute Cooperative Agreement Number
UUUUUUUUUU").

Although the awardee retains custody of and primary rights to the data
developed under this award, the NBLIC Program Director shall be
provided access to all data gathered under this award for periodic
review of data management procedures, data quality, and uses.

o  Supply computerized data, ready for analysis, to the Steering
Committee, which will be comprised of the PI, National Coordinator,
Regional Chairpersons, and Regional Coordinators for possible
assignment to a sub-committee for data analysis.

3.  Other

The PI assumes responsibility for accomplishing the goals and broad
objectives of the NBLIC project and related activities as defined by
the NCAB.  Applications must include detailed program plans that
describe how all project activities relate to the overall goals and
objectives of the program; how evaluation instruments and criteria will
measure the impact and effectiveness; and how the NCI will benefit from
the evaluation information obtained.

The applicant must clearly define and justify proposed geographic
program regions based on the number and distribution of Black Americans
that reside within specified areas.  Equally important, applicants must
describe how they plan to access targeted population and the approach
to be used to form coalitions.

The applicant is expected to include in the application, detailed
policies, procedures, and certain controls that will be in place for
managing the funds and other resources.

Applicant must state willingness and document ability to participate in
the activities above and include those activities in the proposed
budget.  Applicants must state how they plan to meet the "Terms of
Cooperation."

Arbitration Procedures

These "Terms of Cooperation" require that the NBLIC Program Director
make various decisions concerning continuation of an award based on
successful performance of the grantee 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 grantee'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

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

The project is national in scope and specifically targets the
approximately 30 million Black American males and females of all age
groups, who comprise approximately 12 percent of the U.S. population.
Applicants must demonstrate the ability to access and recruit
participants from the Black American community where the cancer
intervention study will be conducted.  The awardee and other key staff
should anticipate that intervention strategies will likely differ among
Black Americans in urban, suburban, and rural areas.  The awardee must
have the competence to adapt program activities accordingly.

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 project,
the name, address, and telephone number of the PI, the names of other
key personnel and cooperating institutions, and the number and title of
the RFA in response to which the application is being submitted.

The NCI requests such letters only for the purpose of providing an
indication of the number of applications to be received and, therefore,
usually does not acknowledge their receipt.  A letter of intent is not
binding and does not enter into the review of subsequent applications.
It allows the NBLIC Program Director to estimate the potential review
workload and to avoid possible conflict of interest in the review.

In a telephone follow-up with the prospective applicant, program staff
may be able to provide assistance and ascertain whether the prospective
applicant has misunderstood the requirements and objectives of the RFA
or opted for an inappropriate funding mechanism.

The letter of intent, to be received no later than April 10, 1992, is
to be mailed to:

Veronica Y. Brown
NBLIC Program Director
National Outreach Initiatives Branch
National Cancer Institute
Executive Plaza South, Room 400C
Bethesda, MD  20892-4200
Telephone:  (301) 496-8680

APPLICATION PROCEDURES

Applicants must clearly define the geographic areas where they will
target their program efforts and demonstrate that the project team will
be able to access all Black American groups within that area.  Where
specific cultural barriers are important, applicants must provide a
plan for addressing those barriers.  Applicants must also provide a
succinct discussion of previous relevant program efforts and plans.

Applicants must provide a detailed plan that describes how all project
activities will be developed and implemented and how they relate to the
overall goals of decreasing cancer incidence and mortality rates for
Black Americans; addressing the barriers that limit or prevent Black
Americans from gaining access to quality health care and referral to
appropriate screening; establishing diagnostic and therapeutic cancer
programs; and, stimulating greater participation of Black Americans in
community outreach programs.  Include in the program plan a detailed
time analysis and strategy for meeting the above requirements.  The
program plan should reflect originality and clearly describe its
scientific significance.

Applicants must describe the criteria for establishing regional offices
in consideration of the numbers of Black Americans in a specified
geographic area.  Proposed regions should have a wide variety of
resources and organizations that collaboratively accomplish the goals
and objectives of the program by networking with coalitions or
consortia.  Examples of organized groups with which to network include:
Black American churches, fraternities and sororities, non-profit
organizations, voluntary and health professional organizations,
community service organizations, governmental organizations,
universities, and the media.

Applicants must describe plans to coordinate activities with government
and non-government agencies to reduce duplication of effort.  Include
in the application an organizational structure and mechanism to
facilitate communication and coordination of collaborative activities
with potential networking groups and agencies such as:

o  NCI Office of Cancer Communications
o  American Stop Smoking Intervention Study Trial (ASSIST)
o  Cancer Information Service (CIS)
o  Data-based Intervention Research Program
o  NCI Designated Cancer Centers (comprehensive and clinical)
o  NCI Designated Community Clinical Oncology Programs
o  OCC Patient Educators Network
o  National Appalachia Leadership Initiative on Cancer (where
appropriate)
o  American Cancer Society
o  State Health Departments
o  Grantees of the Centers for Disease Control's Division of Chronic
Diseases

Applications must include the organization's management practices that
will ensure that program goals and objectives are met and funds
appropriately spent during the award period.

Applicants are to describe the types of prevention-control measures
they intend to utilize and observations and records by which success
will be measured.

Applications must include an appropriately justified budget for each
12-month segment for a total of five years of funding.  Applicants are
strongly encouraged to identify in-kind contributions and/or co-
sponsors for specific personnel activities and facilities.  Applicants
must also describe a fiscal structure that will allow a significant
portion of the budget to be allocated for supporting coalition
activities, (e.g., meetings, mailings, and programs).  The overall
project plan must be within the confines of the proposed budget.

Estimates of staff salaries must include the Principal Investigator and
other professional and support staff.  In estimating travel for the
five-year period, applicants must include estimates for 3 two-day
meetings during Year 1 (Phase I), and 1 two-day meeting every six
months thereafter in Bethesda, MD.

The research grant application form PHS 398 (rev. 9/91) must be used in
applying for the cooperative agreement under this RFA. These forms are
available at most institutional business offices; from the Office of
Grants Inquiries, Division of Research Grants, National Institutes of
Health, Westwood Building, Room 449, 5333 Westbard Avenue, Bethesda, MD
20892; and from the NBLIC Program Director named below.  The
conventional presentation format details described on form PHS 398
should be followed.

The RFA label available in the grant application form PHS 398 must be
affixed to the bottom of the face page.  Failure to use this label
could result in delayed processing of an 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 2a 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 the time of submission, two additional copies of the application
must also be sent to:

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 Division of Research Grants (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

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
RFA is a NCI program staff function.  Applications that are judged
non-responsive will be returned.  Questions concerning responsiveness
to the RFA should be directed to NCI program staff identified in
INQUIRIES below.

If the number of applications is large compared to the number of awards
to be made, the NCI may conduct a preliminary technical peer review
(triage) to eliminate those applications that are clearly not
competitive.  The NCI will remove from competition those applications
judged to be noncompetitive for award and notify the applicant and
institutional business official.

Those applications that are complete and responsive will be evaluated
in accordance with the review criteria stated below for technical merit
by an ad hoc review committee convened by the Division of Extramural
Activities, NCI.  Applicant investigators are advised to structure
their applications so as to address explicitly each of the criteria
enumerated.  The review group will recommend an appropriate budget and
period of support for each approved application.

Review Criteria

Reviewers will evaluate the appropriateness and adequacy of the
outreach approach and methodology proposed to carry out the program.
Applicants must, therefore, document the factors that best describe
cancer control needs of the target population including cancer behavior
risk factors, health care utilization factors, resources and cancer
rates of the population, and access to cancer data bases for the
population.

The qualifications and experience of proposed staff will be judged
based on the degree to which they are appropriate for this program and
demonstrate a broad knowledge of cancer control science and
epidemiology, expertise in health intervention, nutrition, and
behavioral science; experience in fiscal and administrative management
of large and complex projects; experience in public health and health
promotion community programs; awareness of existing cancer prevention
and control needs in Black American communities; experience with
multidisciplinary health care providers; and experience in
collaborating with community agencies, groups, and coalitions in the
conduct of cancer prevention and control intervention programs.
Thorough knowledge of the Black American community, its cultural
nuances, and its behavior and attitudes towards health is essential.

Whereas the programs and activities initiated under this solicitation
will be specifically for Black Americans within the continental United
States, special consideration will be given to applicant institutions
that are located within the Black community.

Applicants will be judged on the degree of originality and creativity
reflected in the ideas on how best to meet the goals of this
announcement; the ability to identify and obtain in-kind contributions
and/or co-sponsors for specific personnel, activities, and facilities;
evidence of understanding the Black American community and its cancer
control needs; the ability to access and obtain participation of
communities, to identify and recruit lay and professional leaders, to
establish community coalitions, and to collaborate with Black health
care and other organizations; the expertise in establishing and
maintaining viable communication channels with broadcast and print
media outlets that serve the Black American community; discussion of
considerations relevant to this RFA; qualifications, training, and
cultural competence of the Principal Investigator, National
Coordinator, and Regional Coordinators, including community outreach
experience and cancer control and communications expertise; capability
to perform the work proposed, and a demonstrated willingness to work
together with the NBLIC Program Director.

Specific review criteria are the following:

o  Comprehensiveness, feasibility, and consistency of the proposed
project plan with the goals and objectives of the RFA and the extent to
which the application demonstrates originality and an understanding of
cancer control outreach activities and community coalition development;

o  Rationale for selection of the targeted geographic area and
documentation of its cancer control needs including cancer-related
behavior risk factors, access and utilization of health care services,
and cancer rates;

o  Adequacy and soundness of the staffing and project management plans,
including evidence of the capability, experience, and qualifications of
the technical staffs at the awardee institution and cooperating
institution, to implement the project successfully and a good overall
balance of the program team in relation to the objectives of the
project;

o  Appropriateness of the implementation plan and the extent to which
it demonstrates consideration of and sensitivity to cultural and
socioeconomic factors in the community including evidence that those
factors are significant targets of inclusion in community coalitions;

o  Evidence of program linkages to existing relevant Federal, State,
and local cancer control plans and activities in target communities,
and a strategy for improving existing plans and stimulating
implementation;

o  Adequacy, appropriateness, feasibility, and comprehensiveness of the
national/regional evaluation plan including sufficient allocation of
resources, maintenance of product standards, and cost containment;

o  Feasibility of the project within the resources and time frames
proposed; appropriateness of the proposed budget and duration in
relation to the proposed initiative; and inclusion of specific written
agreements with cooperating institutions including those agencies that
may be providing services and/or the settings for services;

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

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

AWARD CRITERIA

The anticipated date of award is September 30, 1992.  Applicants 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 Black American groups
targeted for outreach activities, and to those providing plans to
target geographical areas of known high incidence of preventable and
controllable cancers among the targeted population, e.g., areas with
high incidence of cervical cancer.

INQUIRIES

Written and telephone inquiries concerning programmatic issues related
to this RFA are encouraged and should be addressed to the NBLIC Program
Director as listed under Letter of Intent.  The opportunity to clarify
any issues or questions from potential applicants is welcome.

Direct inquiries regarding fiscal matters to:

Eileen Natoli, Team Leader
Grants Administration Branch
National Cancer Institute
Executive Plaza South, Room 243
6120 Executive Boulevard
Bethesda, MD  20892
Telephone:  (301) 496-7800  Ext 56

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No. 93.399.  Awards are made under authorization of the Public Health
Service Act, Title IV, Part A (Public Law 78-410, as amended by Public
Law 99-158, 42 USC 241 and 285) and administered under PHS grants
policies and Federal Regulations 42 CFR 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.  National Cancer Institute, 1987 Annual Cancer Statistics Review
1973-1986.  DHHS Pub. No. (NIH) 89-2789.  Bethesda, MD: U.S. Department
of Health and Human Services, 1988.

2.  GAIL MH: A review and critique of some models used in competing
risk analysis.  Biometrics 31: 209-222, 1975.

3.  1992 NCI Bypass Budget.

4.  National Center for Health Statistics.  Health, United States,
1989.  DHHS Pub. No. (PHS) 90-1232. Washington, DC: U.S. Department of
Health and Human Services, 1990.

.

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