Full Text ES-95-002


NIH GUIDE, Volume 23, Number 35, October 7, 1994

RFA:  ES-95-002

P.T. 34

  Health Services Delivery 

National Institute of Environmental Health Sciences

Letter of Intent Receipt Date:  November 17, 1994
Application Receipt Date:  January 13, 1995


The purpose of this program is to strengthen the NIEHS effort that
supports research aimed at achieving environmental justice for
socioeconomically disadvantaged and medically underserved populations
in the United States.  One goal of the Institute is to stimulate
investigative efforts that attempt to address questions related to the
influence of economic and social factors on the health status of
individuals exposed to environmental toxicants.

This component of the NIEHS research program in environmental justice
is designed to stimulate community outreach, training, and education
efforts which will become the catalyst for reducing exposure to
environmental pollutants in underserved populations.  The main
objective of this RFA is to establish methods for linking members of a
community, who are directly affected by adverse environmental
conditions, with researchers and health care providers.  This will
ensure that:

o  the community is aware of basic environmental health concepts,
issues, and resources;

o  the community has a role in identifying and defining problems and
risks related to environmental exposures;

o  the community is included in the dialogue shaping potential future
research approaches to the problem; and

o  the community actively participates with researchers and health care
providers in developing responses and setting priorities for
intervention strategies.

The aim of this program is to facilitate the process of developing the
trust needed for establishment of effective partnerships among
individuals who are adversely impacted by an environmental hazard in a
socioeconomically disadvantaged community, researchers in environmental
health, and health care providers.


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,
Environmental Justice:  Partnerships for Communication, is related to
the priority area of environmental health.  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).


Applications may be submitted by domestic for-profit and non-profit
organizations, both public and private including predominantly minority
institutions, individually or as joint efforts of minority institutions
and majority institutions.  Usually, only one award under this RFA will
be funded at an institution.  While a single institution must be the
applicant, a multi-institutional arrangement (consortium) is possible.
Such consortia, entailing active participation by more than one
organization, are encouraged if there is clear evidence of close
interaction and responsible partnership among the participants.

It is important to note that, because of the wide range of
environmental health problems to be addressed and the diversity of
affected communities, applications must include at least one of each of
the following:

o  A research scientist in environmental health sciences (such as those
at NIEHS Environmental Health Sciences Centers).

o  A primary health care provider directly involved in a community
affected by an environmental pollutant.  This individual must have a
record of providing health care to the participating community.  He/she
could, but need not necessarily, be affiliated with a county or state
public health department.

o  A member of a community organization in an area having an
underserved population that is adversely affected by an environmental
pollutant.  This individual must be someone who lives in or works
directly and regularly with the participating community.

At least one member of each of these three required personnel groups
must have an active and meaningful role in both development of the
application and conduct of the proposed project.  These personnel
should be listed on page 2 of the PHS 398 application, and a
biographical sketch should be provided for each.  Applications lacking
the required personnel will not be considered.

The role of each member of these three personnel groups in developing
the application and carrying out the project must be clearly identified
and fully described.  There should be an equitable distribution of
responsibilities as well as of requested financial resources among the
three personnel groups.

The NIEHS has a significant commitment to the support of programs
designed to increase the number of underrepresented minority and female
scientists participating in biomedical and behavioral research.
Therefore, applications from minority individuals and women are


This RFA will use the National Institutes of Health (NIH) Education
Grant (R25).  Responsibility for the planning, direction, and execution
of the proposed project will be solely that of the applicant.  The
total project period for applications submitted in response to the
present RFA may not exceed four years, and projects are not renewable.
This RFA is a one time solicitation.


The estimated total funds available for the first year of support for
the entire program are anticipated to be $500,000.  The maximum award
will be $150,000 in direct costs per year.  Indirect costs will be paid
at the approved indirect cost rate for the applicant organization less
appropriate exclusions.  It is anticipated that one to three  grants
will be awarded depending upon the availability of funds for this
purpose and the quality of the applications received.  Awards are not
renewable and supplements are not allowed.



Americans want to live long and healthy lives, and the majority of them
achieve that goal.  In general, however, people who are economically
disadvantaged and/or who live or work in areas and occupations where
conditions impart greater exposure to hazardous substances are less
likely to do so.  At every stage of life, these persons suffer
disproportionate levels of morbidity and mortality.  Evidence suggests
that certain groups, especially minorities and low-income communities,
bear an uneven share of hazardous environmental exposures.
Socioeconomically disadvantaged people suffer the lowest life
expectancy and highest adverse health consequences of inadequate access
to high-quality health care.  Additionally, they most often experience
the highest degree of exposure to environmental agents and frequently
have the least information available as to the health consequences of
exposure to these agents.

Environmental justice refers to the need to remedy the perceived
unequal burden borne by socioeconomically disadvantaged persons in
terms of residential exposure to greater than acceptable levels of
environmental pollution, occupational exposure to hazardous substances,
and fewer civic benefits such as sewage and water treatment.
Geographic location plays an important role in environmental exposure
of socioeconomically disadvantaged persons.  Inner city poor often live
in homes with high lead levels.  They may also be exposed to higher
levels of air pollution.  Toxic wastes sites are more frequent in
rural, low socioeconomic counties in the US.  Nuclear facilities and
chemical plants are often located in rural areas.  Exposure to
pesticides is another example where rural, socioeconomically
disadvantaged populations are at a greater than average risk.
Disadvantaged neighborhoods may rely on well water which may be
polluted with toxic chemicals.  In addition, medical care is often
inadequate or unavailable to a significant proportion of the
socioeconomically disadvantaged and minority people in America today.

Lead poisoning and the cognitive and developmental damage associated
with exposure to lead occur disproportionately among minorities.  High
blood pressure and prostate cancer are very common among
African-Americans.  Low birth weight babies and other problems during
pregnancy are common among groups of women who do not have access to
good prenatal care.  Some of these conditions or other diseases may
have an environmental component in their etiology.  The lack of
resources for early identification of the effects of toxic agents may
lead to an increased disease burden in people who are economically
least able to cope with it.

Recent Progress and Opportunities

Some work has been done to investigate the effects of pesticides in
agricultural workers, of polychlorinated biphenyls in children in rural
areas, and of lead exposure in socioeconomically disadvantaged urban
children.  The effect of low versus high air pollutant exposure on
pulmonary function has been extensively studied.  Evidence from the
NHANES study has shown that, for comparable levels of exposure,
different racial groups have different levels of blood lead.  Some
evidence is also available that suggests the toxic effects of some
agents such as lead can be mitigated by good nutrition.

Many of these studies have engaged underserved populations, but none
have focused on such problems from the perspective of identifying
issues of highest impact on and priority to these populations.  Thus,
progress has been minimal in most areas due to the lack of
well-developed studies targeting socioeconomically disadvantaged
populations.  More effort must be put into defining disadvantaged
populations having high levels of exposure to various types of
environmental hazards in residential or occupational settings.
Comprehensive outcomes to these exposures must be defined and measured.
Prevention and treatment strategies for these effects must also be

Prominent among the goals of the NIEHS is support of research aimed at
achieving environmental justice for all populations.  It is equally
important to bring minority populations into the mainstream of
biomedical research as scientists, health care providers, and allied
health service professionals.  Both of these goals have a clear benefit
to the health of the nation and provide a means of addressing a
potential labor shortage in the twenty-first century.  As one  aspect
of this effort, the Institute is requesting submission of applications
that focus on establishing new avenues of communication among those
living or working in a community impacted by an environmentally related
health problem and the researchers and health care providers attempting
to recognize and ameliorate such problems.

Objectives and Scope

One component of the mission of NIEHS is to promote research aimed at
achieving environmental justice by identifying and addressing
disproportionately high and adverse effects of environmental agents on
human health in low income and minority populations.

The main objective of this program is to establish methods for  linking
members of  a community, who are directly affected by adverse
environmental conditions, with researchers and health care providers.
Development of community-based strategies to address environmental
health problems requires approaches that are not typically familiar to
the research and medical communities.

Customary approaches to risk assessment and management often neglect
the knowledge and experience of at-risk populations and the
sociocultural context of environmental hazards.  The distinctive needs
of individual communities and their inhabitants are only rarely
considered in identifying environmental health problems and devising
appropriate disease and pollution prevention tactics.  Underserved
populations are often diverse, fragmented, and isolated, making it
difficult to obtain their input and to integrate their concerns in
decision- making processes.  Assays of the health effects of
environmental pollution, as well as regulations based on such assays,
are often performed with little or no input from the affected
community.  The purpose of this program is to institute mechanisms to
bridge this communication gap.

Applicants are therefore expected to create equitable partnerships
among researchers in environmental health, health care providers, and
representatives of low-income or minority communities affected by
environmental health problems.

Types of activities which may be proposed include, but are not limited

o  Develop efficacious methods for risk communication in minority and
low-income communities unfavorably impacted by environmental hazards.

o  Develop community-based, culturally sensitive educational programs
to mitigate adverse health effects from environmental toxicants in
minority and low-income communities.

o  Carry out community-based training to increase environmental health
literacy, i.e., increase awareness of the public, in such

o  Train and educate neighborhood health care professionals in the
diagnosis and treatment of disorders having an etiology related to
exposure to hazardous substances, i.e., increase awareness of health
care providers.  These providers should have a direct role in assisting
a community affected by exposure to an environmental hazard.

NIEHS wishes to encourage a broad, comprehensive approach to this
problem.  Applicants are encouraged to consider proposing some
combination of the above activities.

The following factors must be included in applications submitted in
response to this RFA:

o  A means of establishing effective input from an underserved
community affected by an environmental toxicant.  For example,
applicants may consider creating a community-based advisory board or
steering committee to facilitate outreach, planning, and evaluation
efforts.  This input could be obtained directly from members of a
community affected by an environmental toxicant as well as from
representatives of such groups as community and neighborhood
associations, churches, public housing resident councils, community
health centers, local public health service departments, and minority
educational institutions.

o  An objective assessment process designed to identify priority areas
in environmental health as perceived by community members, to develop
a consensus among community members as to plausible approaches, to
build upon existing expertise and knowledge within the community,  and
to detect any potential constraints in implementing the project.

o  Development of appropriate education/communication modules.
Proposed projects should provide for dissemination of relevant
information within the community as well as a means for the community
to have a voice that reaches researchers and health care providers.
There should be an effective flow of information among all

o  Feedback and evaluation of the project's effectiveness.  A procedure
should be established to assess the usefulness of the project's
education/communication activities.

o  Recommendations for future activities, beyond the period of NIEHS
funding, to assure continued participation of community members in
research and service programs addressing environmental injustices.

Each of the above elements is essential to fulfill the education,
communication, and outreach aims of this RFA.  Applications lacking any
of the above components will not be considered.

It is important to note that award of a grant under this RFA by the
NIEHS does not imply a commitment to future funding of any programs
planned with the support of such a grant.  Separate applications must
be submitted for such programs and such applications will be evaluated
on the basis of their own merits.


To encourage applicants to share information gained via these grants,
a member of each of the three types of required personnel on each
project will be asked to attend an annual meeting at NIEHS.  Applicants
should include such travel in their budget requests.


It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results from
the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43)
and supersedes and strengthens the previous policies (Concerning the
Inclusion of Women in Study populations, and Concerning the Inclusion
of Minorities in Study Populations), which have been in effect since
1990.  The new policy contains some provisions that are substantially
different from the 1990 policies.

All investigators proposing research involving human subjects should
read the "NIH Guidelines for Inclusion of Women and Minorities as
Subjects in Clinical Research," which have been published in the
Federal Register of March 28, 1994 (FR 59 14586-14513) and reprinted in
the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18,

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.


Prospective applicants are requested to submit, by November 17, 1994,
a letter of intent that includes a descriptive title of the proposed
project, 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.  The letter of intent influences
neither review nor funding decisions, but it is helpful to NIEHS staff
in planning the review process, e.g., in estimating workload and
avoiding conflict of interest.

Letters of intent are to be directed to:

Ethel B. Jackson, D.D.S.
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD 17-09
104 T.W. Alexander Drive
Research Triangle Park, NC  27709


Applicants are to use standard form PHS 398 (rev 9/91), which is
available from most institutional offices of sponsored research from
the Office of Grants Information, Division of Research Grants, National
Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892,
telephone (301) 710-0267).

The RFA label available in the PHS 398 (rev. 9/91) application form
must be affixed to the bottom of the face page of the application.
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

In order to assure proper identification of the application, item 2a of
the application form must be filled in as follows:  Check the box
indicated as "YES" enter the RFA number as ES-95-002 and the title as
"Environmental Justice:  Partnerships for Communication."  Each
application must be presented in the format used for an NIH research

Submit a signed, typewritten original of the application, including the
Checklist and three signed 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 be sent to:

Ethel Jackson, D.D.S.
Division of Extramural Research & Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD 17-09
104 T.W. Alexander Drive
Research Triangle Park, NC  27709

Applications must be received by January 13, 1995.  If an application
is received after that date, it will be returned to the applicant
without review.  The Division of Research Grants (DRG) will not accept
any application in response to this RFA that is essentially the same as
one currently pending initial review, unless the applicant withdraws
the pending application.  The DRG will not 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.  Applicants who are submitting
revised applications based on criticisms in summary statements received
in response to the previous announcement of this RFA, ES-94-005, are
urged to read the appropriate instructions on pages 19-20 of the PHS
398 and to contact program staff listed under INQUIRIES.

All human and animal welfare as well as misconduct assurances must be
complete for a application to be reviewed.  All follow-up assurances
and approvals submitted as pending must be received within 60 days of
the application receipt deadline as the application will not be

The following is the schedule planned for this initiative.  It should
be noted that this schedule may be changed without notification due to
factors that were unanticipated at the time of the announcement.
Please contact the program official listed below regarding any changes
in the schedule.

Letter of Intent Receipt Date:  November 17, 1994
Application Receipt Date:       January 13, 1995
Initial Scientific Review:      March 1995
Advisory Council Review:        May 1995
Anticipated Date of Award:      July 1, 1995


Review will be carried out by the Scientific Review Branch, Division of
Extramural Research and Training.  Applications will be screened by
staff for completeness and responsiveness to the RFA.  Those that are
incomplete or nonresponsive will be returned to the applicant without
review.  Complete and responsive applications will be reviewed by
either the Environmental Health Sciences Review Committee or a special
review committee impaneled by the Scientific Review Branch.

As part of the initial merit review, a process (triage) may be used by
the initial review group in which applications will be determined to be
competitive or noncompetitive based on their scientific merit relative
to other applications received in response to the RFA.  Applications
judged to be competitive will be discussed and be assigned a priority
score.  Applications determined to be noncompetitive will be withdrawn
from further consideration and the Principal Investigator and the
official signing for the applicant organization will be notified.  The
second level of review will be provided by the National Advisory
Environmental Health Sciences Council.

The review factors listed below will be used in evaluation of
applications for this RFA:

o  Scientific, technical, and/or medical significance and merit of the
proposed project as determined by such factors as its content,
originality, and feasibility.

o  Evidence of access to, interaction with, and input from a minority,
low-income, or underserved community, whose members' health is
adversely impacted by an environmental toxicant.  There should be
evidence of effective involvement of such a community in development of
the application as well as in conduct of the project.

o  Capacity of the project to:

1.  Identify key environmental hazards that affect the health and
quality of life of people who live in or around communities thought to
be at risk.

2.  Establish a focus for information exchange related to environmental
health problems in socioeconomically disadvantaged communities.

3.  Enhance awareness of environmental health problems among members of
the public and/or health care providers living or working in minority
or low-income communities.

4.  Have a direct impact on the health or quality of life of
individuals in affected communities, e.g., by diminishing exposure to
environmental toxicants.

o  Appropriateness and adequacy of the approach and methodology
proposed to accomplish the project's objectives.  Effectiveness of the
proposed plan in reaching the target audience.  For example, many
socioeconomically disadvantaged persons tend not to obtain information
from the written word.  Low- or no-literacy, as well as bilingual,
materials may need to be generated.

o  Qualifications and experience of the principal investigator and
staff, particularly but not exclusively in areas relevant to the
mission of NIEHS.  Personnel should demonstrate knowledge of the needs
of their target audience.  Applications must include, at a minimum, a
researcher in environmental health sciences, a health care provider,
and a member of a community organization in an area having an
underserved population that is adversely affected by an environmental
pollutant.  There should be evidence of effective cooperation and
interaction among these staff members in development of the application
as well as in execution of the project.  There should be an equitable
distribution of responsibilities among the three types of required

o  Strength of institutional commitment as evidenced by provision of
appropriate resources, services, technical support, and allocation of

o  Availability of resources necessary to carry out the project.

o  Appropriateness of the proposed budget and duration in relation to
the project's objectives.  Consistent with an equitable distribution of
responsibilities, there should likewise be an equitable distribution of
requested financial support among the three types of required

o  Plans for evaluation of factors contributing to the project's
effectiveness.  Evaluations should include a measure of the impact of
the project on community members' knowledge and awareness of issues and
resources related to environmental health sciences.


The anticipated date of award is July 1, 1995.  The following will be
considered in making funding decisions:

o  Quality of the proposed applications as determined by peer review.

o  Responsiveness to the goals of this RFA and the mission of the

o  Availability of funds.  Although this program is provided for in the
financial plans of the NIEHS, awards pursuant to this RFA are
contingent upon the availability of funds for this purpose.  Funding
beyond the first and subsequent years of the award will be contingent
upon satisfactory progress during the preceding year and upon
availability of funds.


Inquiries concerngin this RFA ar encouraged.  The opportunity to
clarify any issues or questions from potential applicants is welcome.

Allen Dearry, Ph.D.
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD 3-02
Research Triangle Park, NC  27709
Telephone:  (919) 541-7825 / 4943
FAX:  (919) 541-2843

Direct inquiries regarding fiscal matters to:

Ms. Carolyn Winters
Division of Extramural Research and Training
National Institute of Environmental Health Sciences
P.O. Box 12233, MD 2-01
Research Triangle Park, NC  27709
Telephone:  (919) 541-7623
FAX:  (919) 541-2860


This program is described in the Catalog of Federal Domestic Assistance
Number 93.113, 93.114, and 93.115.  Awards are made under authorization
of the Public Health Service Act, Title IV, Part A (Public Law 100-607)
and administered under PHS grants policies and Federal Regulations 42
CFR Part 52 and 45 CFR Part 74.  The program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.

The Public Health Service (PHS) strongly encourages all grant
recipients to provide a smoke-free workplace and promote the non-use of
all tobacco products.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American


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