ENVIRONMENTAL JUSTICE: PARTNERSHIPS FOR COMMUNICATION Release Date: May 29, 1998 RFA: ES-98-006 P.T. National Institute of Environmental Health Sciences Letter of Intent Receipt Date: July 1, 1998 Application Receipt Date: October 27, 1998 PURPOSE The purpose of this program is to strengthen the National Institute of Environmental Health Sciences (NIEHS) support of research aimed at achieving environmental justice for socioeconomically disadvantaged and medically under served populations in the United States. One goal of the NIEHS 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, research and education efforts that will become the catalyst for reducing exposure to environmental pollutants in under served 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 and to enable this partnership to develop appropriate research strategies to address environmental health problems of concern. This effort 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 research approaches to the problem. o The community actively participates with researchers and health care providers in developing responses and setting priorities for intervention strategies. One 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. Once this aim is achieved, the collaborative team should then be able to initiate a research program that incorporates all parties and seeks to reduce exposure to or health impact from an environmental contaminant. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Health 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 Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone: (202) 512-1800. ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic for-profit and non-profit organizations, 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 or organization. Although a single institution or organization 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. Competitive continuation applications from existing grantees in the NIEHS Environmental Justice: Partnerships For Communication program in their fourth year of support will be accepted for consideration under this RFA. Such applications must follow PHS 398 guidelines for competitive renewal, including a progress report. Such applicants are strongly encouraged to contact Program Staff listed under INQUIRIES for additional guidance. 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 under served 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 must be listed on page 2 of the PHS 398 application, and a biographical sketch must 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. This goal is often accomplished through the inclusion of one or more subcontract arrangements, which may be helpful in defining all parties" programmatic and budgetary roles. 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 encouraged. Because of the community-based nature of this program, well-established community-based organizations are encouraged to consider their capacity to serve as the primary applicant organization. Due to the complex administrative, programmatic, and financial responsibilities associated with this role, such groups should contact Program Staff listed below for guidance. MECHANISM OF SUPPORT 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 an application submitted in response to the present RFA may not exceed four years. FUNDS AVAILABLE The estimated total funds available for the first year of support for the entire program are anticipated to be $1.5 million. The maximum award will be $200,000 in direct costs, including subcontract total (direct plus indirect) 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 five grants will be awarded depending upon the availability of funds for this purpose and the quality of the applications received. Supplements are not allowed. 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. RESEARCH OBJECTIVES Background 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 the 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 about the health consequences of exposure to these agents. Environmental justice refers to the need to remedy the 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 waste sites are more frequent in rural, low socioeconomic counties in the U.S. Nuclear facilities and chemical plants are often located in rural areas. Exposure to pesticides is another example where rural, socioeconomically disadvantaged populations area 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 prostrate 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 Over the past five years, the NIEHS has supported a variety of environmental justice and community-based prevention/intervention research programs. These programs have been very successful in achieving open and honest communication between researchers and community members. Working together, researchers and community leaders have been able to identify disproportionate environmental health risks in certain communities and have begun to formulate research agendas. A needed step in this process is gaining participation of community members in efforts to gather preliminary health and exposure data. Ongoing projects within the NIEHS Environmental Justice: Partnerships For Communication program are committed to enhancing community participation in research studies and to facilitating communication among environmental health researchers, community health care providers, and community members. Methods utilized in these projects include: o Assessment and/or surveys of environmental hazards. o Characterization and evaluation of the distribution and health impact of environmental contaminants. o Provision of environmental health and toxic exposure training for health care providers. o Development of culturally appropriate education and communication materials. o Development and implementation of exposure reduction/pollution prevention strategies. 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 objectives of this program are to: establish methods for linking members of a community, who are directly affected by adverse environmental conditions, with researchers and health care providers, and enable this partnership to develop appropriate research strategies to address environmental health problems of concern. Development of such 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. Under served 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. Once communication and collaboration have been achieved, researchers and community members should then develop a research agenda to identify and assess environmental risks. Establishing and maintaining trust among all personnel is important throughout the process, as it will enhance the capacity to collect preliminary health and exposure data. The ultimate goal of this program is to reduce health threats to these populations. Therefore, participation of the community is essential for both identification of health risks as well as for effective implementation of policies to reduce exposure. Applicants are therefore expected to create equitable partnerships among researchers in environmental health, health care providers, and representatives of low income or medically under served communities affected by environmental health problems. Types of activities that may be proposed include, but are not limited to: o Develop efficacious methods for risk communication in low-income and under served communities unfavorably impacted by environmental hazards. o Develop community-based, culturally sensitive educational programs to mitigate adverse health effects from environmental toxicants in low-income and under served communities. o Carry out community-based training to increase environmental health literacy, i.e., increase awareness of the public, in such neighborhoods. 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. o Develop a research agenda to measure population exposure and/or quantify human health impacts. The NIEHS wishes to encourage a broad, comprehensive approach to this problem that emphasizes both education and research. 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. Applications lacking any one of the following factors will be considered nonresponsive. Potential applicants are strongly encouraged to consult program staff listed under INQUIRIES about their capacity to address each of these factors. The required elements for each application are: o A means of establishing effective input from an under served 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. - Develop a consensus among community members about plausible approaches. - Build upon existing experience and knowledge within the community. - Detect any potential constraints in implementing the project. o Development of appropriate education/communication modules. Proposed projects must 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. o Develop research and intervention approaches. For example, projects to collect and analyze exposure/health data are appropriate and encouraged. o Evaluation of the project"s effectiveness. A procedure must be established to assess the usefulness of the project"s education, communication and research activities. Both process and outcome measures should be addressed. 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, research and outreach aims of this RFA. Applicants lacking any of the above components will be considered nonresponsive. 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. Activities conducted under this RFA should be consistent with Federal Executive Order No. 12988 entitled, "Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations." To the extent practicable and permitted by law, grantees shall make achieving environmental justice part of their project"s mission by identifying and addressing, as appropriate, disproportionately high and adverse human health effects of environmental contaminants on minority, low-income, and medically under served populations, including African, Hispanic, Asian, and Native Americans. SPECIAL REQUIREMENTS To encourage applicants to share information gained via these grants, a member of each of the three types of required personnel on each project (scientist, health care provider, and community member) will be asked to attend an annual meeting at NIEHS. Applicants should include such travel in their budget requests. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS 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 policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103 43). All investigators proposing research involving human subjects should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. 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. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all NIH conducted or supported research involving human subjects, including research that is otherwise "exempt" in accord with Sections 101 (b) and 401(b) of 45 CFR 46 þ Federal Policy for the Protection of Human Subjects. The inclusion of children as subjects in research must be in compliance with all applicable subparts of 45 CFR 46 as well as with other pertinent federal laws and regulations. Therefore, proposals for research involving human subjects must include a description of plans for including children. If children will be excluded from the research, the application or proposal must present an acceptable justification for the exclusion. LETTER OF INTENT Prospective applicants are requested to submit, by July 1, 1998, 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. Although a letter of intent is not required, is not binding, and does not enter into review of a subsequent application, the information that it contains is helpful in planning for the review of applications. It allows NIEHS staff to estimate the potential review workload and avoid conflict of interest. The letter of intent is to be sent to: Ethel B. Jackson, D.D.S. Division of Extramural Research and Training National Institute of Environmental Health Sciences P.O. Box 12233, MD EC-24 111 T.W. Alexander Drive Research Triangle Park, NC 27709 Telephone: (919) 541-7826 FAX: (919) 541-2503 Email: jackson4@niehs.nih.gov APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 5/95) is to be used in applying for these grants. These forms are available at most institutional offices of sponsored research and may be obtained from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, Email: GrantsInfo@nih.gov. The RFA label available in the PHS 398 (rev. 5/95) 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 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 the YES box must be marked. Submit a signed, typewritten original of the application, including the checklist, and three signed, photocopies, in one package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040 þ MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must be sent to: Ethel Jackson, D.D.S. Division of Extramural Research and Training National Institute of Environmental Health Sciences P.O. Box 12233, MD EC-24 111 T.W. Alexander Drive Research Triangle Park, NC 27709 Applications must be received by October 27, 1998. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) 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 CSR 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. All human and animal welfare as well as misconduct assurances must be complete for an application to be reviewed. All follow up assurances and approvals submitted as pending must be received within 60 days of the application receipt deadline or the application will not be reviewed. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by the NIEHS. Applications that are incomplete and/or nonresponsive will be returned to the applicant without review. Complete and responsive applications will be evaluated for scientific and technical merit by a peer review group convened by the NIEHS in accordance with review criteria stated below. As part of the initial merit review, a process 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 major 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 under served 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: - 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. - Establish a focus and appropriate strategies and procedures for information exchange related to environmental health problems in socioeconomically disadvantaged communities. - Enhance awareness of environmental health problems among members of the public and/or health care providers living or working in low-income or under served communities. - 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 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. Similarly, evaluation of the effectiveness of health care provider training should be conducted. Both process and outcome evaluation tools should be incorporated. 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. There should be evidence of effective cooperation and interaction in development of the application as well as in execution of the project among the three types of required personnel: a researcher in environmental health sciences, a health care provider, and a member of a community organization in an area having an under served population that is adversely affected by an environmental pollutant. There should be an equitable distribution of responsibilities among the three types of required personnel. o Strength of institutional commitment as evidenced by provision of appropriate resources, services, technical support, and allocation of space. 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 personnel. o Adequacy of plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the research when human subjects are used. Plans for the recruitment and retention of subjects will also be evaluated. AWARD CRITERIA The anticipated date of award is July 1, 1999. The following will be considered in making funding decisions: o Quality of the proposed applications as determined by peer review. o Significance with respect to the goals of this RFA and the priorities of the NIEHS. o Availability of funds. Schedule The following is the schedule planned for this initiative. It should be noted that this schedule might be changed without notification due to factors that were unanticipated at the time of the announcement. Contact the program official below regarding any changes in the schedule. Letter of Intent Receipt Date: July 1, 1998 Application Receipt Date: October 27, 1998 Initial Scientific Review: February, 1999 Advisory Council Review: May 1999 Anticipated Date of Funding: July 1, 1999 INQUIRIES Written, telephone or Email inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Allen Dearry, Ph.D. Division of Extramural Research and Training National Institute of Environmental Health Sciences P.O. Box 12233, 111 T.W. Alexander Drive, MD EC-21 Research Triangle Park, NC 27709 Telephone: (919) 541-4500 FAX: (919) 541-4937 Email: dearry@niehs.nih.gov Direct inquires regarding fiscal matters to: Mr. David L. Mineo Division of Extramural Research and Training National Institute of Environmental Health Sciences P.O. Box 12233, 111 T.W. Alexander Drive, MD EC-22 Research Triangle Park, NC 27709-2233 Telephone: (919) 541-7628 FAX: (919) 541-2860 Email: mineo@niehs.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Nos. 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 grant 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 PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases an portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people.

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