Full Text NR-93-002

COMMUNITY INTERVENTIONS IN ADOLESCENT HEALTH PROMOTION

NIH GUIDE, Volume 22, Number 5, February 5, 1993

RFA:  NR-93-002

P.T. 34, AA

Keywords: 
  Community/Outreach Programs 
  Health Promotion 
  Behavioral/Social Studies/Service 


National Center for Nursing Research

Letter of Intent Receipt Date:  March 25, 1993
Application Receipt Date:  April 29, 1993

PURPOSE

The National Center for Nursing Research (NCNR) invites submissions
of R01 applications for investigations of community based
interventions for health promotion and disease prevention in older
children and adolescents (ages 8-18).  The purpose of this Request
for Applications (RFA) is the development and testing of community
based interventions that focus on helping older children and
adolescents adopt and maintain health-promoting cognitive and
behavioral patterns.  Health promotion strategies could take place in
traditional and nontraditional settings, with focus, if possible, on
highly vulnerable youth, including minority, economically
disadvantaged, and disabled subgroups.

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,
Community Interventions in Adolescent Health Promotion, is related to
the priority areas of health promotion in educational and community
based programs, and preventive services for HIV infection and
sexually transmitted diseases.  Potential applicants may obtain a
copy of the "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 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign for-profit and
non- profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Applications from minority individuals and women are encouraged.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) individual
research grant (R01).  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 three years.  This RFA is
a one-time solicitation.  Future unsolicited competing continuation
applications will compete with all investigator-initiated
applications and be reviewed according to the customary peer review
procedures.  Because the nature and scope of the research proposed
may vary, it is anticipated that the size of the award will vary
also.  The anticipated average direct cost award per year will range
from $150,00 to $180,00.  The anticipated award date will be
September 30, 1993.

FUNDS AVAILABLE

Approximately one million dollars in total costs for the first year
will be committed to specifically fund applications submitted in
response to this RFA.  It is anticipated that four to five
applications will be funded for a three year period.  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 NCNR, awards pursuant to this
RFA are contingent upon the availability of funds for this purpose.

RESEARCH OBJECTIVES

o  Develop and test family, school, and community strategies for
adopting and maintaining health-promoting behaviors among youth in
traditional health care settings such as emergency facilities,
school-based clinics, and medical offices.

o  Develop and test alternative health promotion models and outreach
strategies in urban and rural settings such as youth-serving
community agencies, shelters for runaways and the homeless, malls,
churches, and youth-employing worksites.

Studies are needed to identify traditional health care settings and
nontraditional settings that, when combined with appropriate health
promotion strategies, might offer the greatest potential for
effectively reaching vulnerable youth.  Recognizing that the
multidisciplinary nature of health promotion research requires a
blending of research expertise from many disciplines, collaboration
with colleagues in the biomedical and social sciences is encouraged.

Health promotion is recognized as a high priority in health research.
More than the absence of disease, health is a positive process of
reaching one's potential in nonphysical as well as physical areas
that is mediated by the biological, cognitive, psychological, social
systems such as family, neighborhood, community, race, culture.
Health professionals have demonstrated the importance of intervening
to promote health and prevent disease rather than delaying
intervention until after a disease process has begun.

Health promotion is particularly important for older children and
adolescents.  For the purposes of this RFA, the age group of older
children and adolescents encompasses ages 8-18.  Most causes of
mortality and morbidity in older children and adolescents are due to
behavior and lifestyle factors and are, therefore, preventable.  Many
of the behavior patterns developed in late childhood and adolescence
carry over into adulthood, and most of the leading health problems of
adults, such as heart disease and obesity, are associated with
behaviors initiated early in life.  Positive changes in health
values, attitudes, and habits in childhood and adolescence are likely
to result in a healthier adulthood.

Nursing practice offers many opportunities for health promotion in
this age group.  Nurses come into direct contact with older children,
adolescents, and their caregivers in a wide range of health,
educational, and health service settings.  The field of nursing
contributes a special breadth and depth to health promotion through
an understanding of developmental changes and the integration of
their effects on health and health-related lifestyles.  Nurses serve
in the roles of counselors, advocates, educators, and caregivers.

Older children and adolescents typically have difficulty applying
their potential for more complex thinking to practical decisions
involving health issues--such as substance use, sexual behavior, and
driving a motor vehicle.  Such decisions are especially problematic
when made under stressful and time-limited circumstances.  Factors
that help youth use their increased cognitive capacities in daily
life include: (1) practice with effective simulations of real
situations, and (2) opportunities to learn cognitive processes
(thinking skills) and relevant content (knowledge) simultaneously,
rather than acquiring thinking skills independently of the context in
which they will be implemented.  Such findings have significant
implications for health promotion research and interventions.

Advances in developmental theories can inform the study of basic
explanatory mechanisms of behavioral acquisition, change, and
maintenance in late childhood and adolescence.  Examining the health
behaviors of children and adolescents within a developmental
perspective facilitates exploration of how internal factors
(individual genetic profiles and biological, emotional and cognitive
processes) interact to influence health behavior and outcomes.  Such
research has great potential for making significant contributions to
the state of the science of health promotion for older children and
adolescents.  In order to have a solid scientific base for practice,
much remains to be learned about the differences and commonalities
across health beliefs, actual and perceived options, behaviors, and
effective health promoting interventions in this population.

Of special concern are the highly vulnerable youth including young
people who are members of minority subgroups (African American,
Native American, Hispanic, and Asian American youth), immigrants,
economically disadvantaged, homeless, and disabled.  Design and
implementation of effective health promotion programs will require
examining the unique cultural factors that influence health.
Research methods must be adapted to provide meaningful and accurate
data about differences between and within ethnic and gender subgroups
of young people; culturally and gender sensitive health promotion
interventions aimed at ethnic minority youth must be designed and
tested.  A detailed understanding also is needed of the constraints
and opportunities for promoting healthy lifestyles among youth in
rural settings.

Guidance and recommendations for this RFA have been provided by the
Priority Expert Panel on Health Promotion for Older Children and
Adolescents convened by the National Center for Nursing Research,
NIH.

STUDY POPULATIONS

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

NIH policy is that applicants for NIH clinical research grants and
cooperative agreements are 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.

The composition of the proposed study population must be described in
terms of gender and racial/ethnic group.  In addition, gender and
racial/ethnic issues must be addressed in developing a research
design and sample size appropriate for the scientific objectives of
the study.  This information must be included in the form PHS 398
(rev. 9/91) in Sections 1-4 of the Research Plan AND summarized in
Section 5, Human Subjects.  Applicants are urged to assess carefully
the feasibility of including the broadest possible representation of
minority groups.  However, NIH recognizes that it may not be feasible
or appropriate in all research projects to include representation of
the full array of United States racial/ethnic minority populations
(i.e., Native Americans [including American Indians or Alaskan
Natives], Asian/Pacific Islanders, Blacks, Hispanics).  The rationale
for studies on single minority population groups should be provided.

For the purpose of this policy, clinical research is defined as human
biomedical and behavioral studies of etiology, epidemiology,
prevention (and preventive strategies), diagnosis, or treatment of
disease, 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.

For foreign awards, the policy on inclusion of women applies fully;
since the definition of minority differs in other countries, the
applicant must discuss the relevance of research involving foreign
population groups to the United States' populations, including
minorities.

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 or minorities 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 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 March 25, 1993, a
letter of intent that includes a descriptive title of the proposed
research, the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and consultants,
the 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 the review of subsequent applications, the information
that it contains is helpful in planning for the review of
applications.  It allows NCNR staff to estimate the potential review
workload and to avoid conflict of interest in the review.

The letter of intent is to be sent to:

Ethel B. Jackson, D.D.S.
Chief, Office of Scientific Review
National Center for Nursing Research
Building 31, Room 5B25
Bethesda, MD  20892
Telephone:  (301) 496-0472
FAX:  (301) 480-4969

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 9/91) is to be used
in
applying for these grants.  These forms are available at most
institutional
offices of sponsored research and from the Office of Grants
Inquiries, Division of
Research Grants, National Institutes of Health, 5333 Westbard Avenue,
Room 449, Bethesda, MD 20892, telephone 301/496-7441.

The RFA label available in the 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 review.  In
addition, the RFA title and number must be typed on line 2a 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:

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:

Ethel B. Jackson, D.D.S
Chief, Office of Scientific Review
National Center for Nursing Research
Building 31, Room 5B25
Bethesda, MD  20892

If the applicant has an approved assurance covering the research, the
applicant should provide the application certification of
Institutional Review Board (IRB) approval if humans are involved.
These reviews and approvals should occur prior to submission of the
application for award and the certifications should be submitted with
the application.  There is no 60 day grace period for RFAs.  If
humans will be subjects of the research at performance sites other
than the applicant organization, the applicant must identify, in the
application, the assurance status of each participant.  Failure to
provide required certifications in the application could result in
delay of an award.  Instructions regarding inclusion of human
subjects are given on pages 22-23 and 25-28 of PHS 398 (rev. 9/91).

Applications must be received by April 29, 1993.  If an application
is received after that date, it will be returned to the applicant.
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.  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.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed by NIH staff for
completeness and responsiveness.  Incomplete applications will be
returned to the applicant without further consideration.  If the
application is not responsive to the RFA, NCNR staff will contact the
applicant to determine whether to return the application to the
applicant or submit it for review in competition with unsolicited
applications at the next review cycle.

Applications may be triaged by an NCNR peer review group on the basis
of relative competitiveness.  The NIH will withdraw from further
competition those applications judged to be non-competitive for award
and notify the applicant Principal Investigator and institutional
official.  Those applications judged to be competitive will undergo
further scientific merit review.  Those applications that are
complete and responsive will be evaluated in accordance with the
criteria stated below for scientific/technical merit by an
appropriate peer review group convened by NCNR.  The second level of
review will be provided by the NCNR advisory council.

Review criteria for RFAs are generally the same as those for
unsolicited research grant applications.

o  scientific and technical significance and originality of proposed
research;

o  appropriateness and adequacy of the experimental approach and
methodology proposed to carry out the research;

o  qualifications and research experience of the Principal
Investigator and staff, particularly, but not exclusively, in the
area of the proposed research;

o  availability of resources necessary to perform the research;

o  appropriateness of the proposed budget and duration in relation to
the proposed research.

AWARD CRITERIA

The anticipated date of award is September 30, 1993.  Decisions to
make awards are based on the scientific merit of the application
reflected in the priority score, availability of funds within NCNR
for this purpose, and NCNR research program priorities.

INQUIRIES

Written amd telephone inquiries concerning this RFA are encouraged.
NCNR program staff welcome the opportunity to clarify any issues or
questions from potential applicants.

Direct inquiries regarding programmatic issues to:

Martha Ann Carey, Ph.D., R.N.
Health Promotion/Disease Prevention Branch
National Center for Nursing Research
Westwood Building, Room 754
Bethesda, MD  20892
Telephone:  (301) 402-3293

Direct inquiries regarding fiscal and administrative matters to:

Sally A. Nichols
Grants Management Officer
National Center for Nursing Research
Westwood Building, Room 748
Bethesda, MD  20892
Telephone:  (301) 496-0237

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance No. 93.361 Nursing Research.  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 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.

.

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