INNOVATIVE APPROACHES TO DISEASE PREVENTION THROUGH BEHAVIOR CHANGE

NIH Guide, Volume 26, Number 36, October 24, 1997

RFA:  OD-98-002

P.T.

Office of Behavioral and Social Sciences Research
Office of Disease Prevention
Office of Research on Women's Health
Office of Alternative Medicine
Office of Dietary Supplements
National Cancer Institute
National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute on Alcohol Abuse and Alcoholism
National Institute of Allergy and Infectious Diseases
National Institute of Arthritis and Musculoskeletal and Skin
Disease
National Institute of Child Health and Human Development
National Institute of Dental Research
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Mental Health
National Institute of Neurological Disorders and Stroke
National Institute of Nursing Research
American Heart Association

Letter of Intent Receipt Date:  April 1, 1998
Application Receipt Date:  May 21, 1998

PURPOSE

The above named organizations invite applications for a four year
research grant program to test interventions designed to achieve
long-term health behavior change.  The health behaviors of
interest-- tobacco use, insufficient exercise, poor diet, and
alcohol abuse--are among the top ten causes for morbidity and
premature mortality.  This Request for Applications (RFA) solicits
intervention studies aimed at either comparing alternative theories
related to mechanisms involved in behavior change, or assessing the
utility of a particular theoretical model for changing two or more
health-related behaviors, rather than simply demonstrating the
efficacy of a single behavior change program.

The sponsoring organizations are jointly issuing this Request for
Applications (RFA) because tobacco use, exercise, diet, and alcohol
abuse are behaviors with implications for a wide array of health
outcomes for both women and men, including cancer, infectious and
allergic diseases, osteoporosis, diabetes, heart disease,
arthritis, depression, periodontal diseases, obesity, and kidney
diseases, as well as related outcomes such as mood and affect,
functional impairment, disability, quality of life, and health care
utilization. The behaviors of interest also share a common
conceptual  basis for change, and  can benefit from findings from
research on learning, motivation, risk perception, decision making,
social influence, and the like.  Because many facets of
understanding the process of behavioral change  are shared, a
combined effort is efficient for the agencies and scientists alike.
The RFA is intended to not only address the missions of the
different organizations, but also go beyond what any single
organization would be likely to accomplish individually.

Throughout the life span, the health effects of social and
behavioral factors such as smoking, drinking, physical activity,
and diet have been dramatically demonstrated.  Most of these
studies, however, have examined one health practice at a time
(e.g., increased exercise) or focused on an individual intervention
approach (individual skill building techniques), despite complex
interactions between various health habits and their maintenance
through reinforcement at several levels: the individual, family,
and community as a whole. Most previous research has targeted easy-
to-reach populations, rather than testing the effectiveness and
applicability of interventions for vulnerable populations in
diverse ethic/minority, groups, age groups, and geographic regions. 
Past efforts have typically focused on short term behavioral
change, yielding  little information on how change, once achieved,
can be maintained over the long term.  The goal of the present
initiative is to address these important gaps in our knowledge
regarding effective disease prevention strategies.

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, "Innovative Approaches to Disease Prevention
through Behavior Change," is related to the priority areas of
physical activity and fitness, nutrition, tobacco, alcohol and
other drugs, mental health and mental disorders, maternal and
infant health, heart disease and stroke, cancer, diabetes and
chronic disabling conditions, immunization and infections diseases,
and clinical preventive services.  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

Applications may be submitted by any domestic for-profit or non-
profit organizations, public or private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, or eligible agencies of the Federal government. 
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the NIH individual research project grant (R01)
mechanism of support.  Submission of coordinated R01 applications
which permit replication of an intervention in multiple sites is an
option.  However, the combined budgets for these coordinated
applications should stay within the budgetary guidelines for a
single project grant.

FUNDS AVAILABLE

It is anticipated that for fiscal year 1999, $3,700,000 total funds
(direct and indirect costs) will be available. Award of grants
pursuant to this RFA is contingent upon receipt of both
sufficiently meritorious applications and funds for this purpose. 
Between 5 and 8 awards are anticipated, not to exceed $700,000 in
annual total cost per individual grant.  The exact amount of
funding awarded will depend on the quality of applications and the
availability of funds.

Applicants should provide a detailed time frame describing what
specific activities are to occur throughout the proposed grant
period, justifying time estimates.  Applicants may request support
for up to four years.  The usual PHS policies governing grants
administration and management will apply.  Annual awards will be
made, subject to continued availability of funds and progress
achieved.  This RFA is a one-time solicitation.  At the end of each
project's  official award period, a competitive renewal application
may be submitted for peer review and competition for support
through the regular grant programs of the NIH.  It is anticipated
that awards resulting from RFA OD-98-002 may begin as early as
April 1, 1999.  Administrative adjustments in project period or
amount of support may be required at the time of the award.  Since
a variety of approaches would represent valid responses to this
RFA, it is anticipated that there will be a range of costs among
the grants awarded.  All current policies and requirements that
govern the research grant programs of the NIH will apply to grants
awarded in connection with this RFA.

RESEARCH OBJECTIVES

Background

The RFA is responsive to several recent reports calling for
increased research on key health behaviors and life style factors
affecting disease. In its broadest sense, this RFA is responsive to
a Human Capital Initiative Strategy Report entitled, "Doing the
Right Thing: A Research Plan for Healthy Living," sponsored by the
American Psychological Association and the National Institute of
Mental Health, and prepared through a collaboration among
representatives of 23 organizations. This Report noted the U.S.
Public Health Service finding that seven of the 10 leading causes
of death could be reduced substantially if people at risk would not
only adhere to medical recommendations, but also change four other
behaviors: tobacco use, exercise, diet, and alcohol abuse. The 
Research agenda is also responsive to recommendations emanating
from the October 6-8, 1993 NIH Office of Disease Prevention and
Health Promotion Conference "Disease Prevention Research at NIH: an
Agenda for All" (Preventive Medicine, September 1994). The
initiative is also responsive to recommendations of the September
4-6, 1991 "Report of the National Institutes of Health:
Opportunities for Research on Women's Health." This report called
for research on interventions for long term weight management,
smoking cessation, and increasing physical activity, behaviors
important for addressing osteoporosis, breast and lung cancer,
heart disease, and other serious health problems affecting women. 
The RFA is also responsive to an 1992 Office of Alternative
Medicine-sponsored workshop, "Alternative Medicine, Expanding
Medical Horizons," which specifically cited the use of alternative
dietary regimens for the prevention and treatment of chronic
diseases.  The report highlights the need for effectiveness trials
in real-world settings, since even a regimen with proven efficacy
can be ineffective if accompanied by a substantial drop-out rate
over time.

This initiative is timely, given both the recent efforts of the
Clinton Administration to curb teenage tobacco use, as well as
recent priorities announced by the NCI in their 1996 Working Group
Report on Priorities in Behavioral Research in Cancer Prevention
and Control, which emphasized the need for studies promoting the
development of innovative behavioral interventions for diet,
exercise, and teenage tobacco use.  Additional recent research
encouragement is given in the July 1996 document entitled 
"Physical Activity and Health: A Report of the Surgeon General",
which concluded that a daily regimen of moderate exercise will
reduce risks of developing coronary heart disease, hypertension,
colon cancer, diabetes, and depression, and is important for the
health of muscles, bones, and joints.  Finally, the National
Invitational Conference on Self Care in Later Life sponsored by the
National Institute on Aging and the Partnership for Prevention
concluded with a set of recommendations urging more research on
theory driven interventions directed at helping older people
initiate and maintain more healthy lifestyles.  Attention to the
clustering of different health practices was seen as particularly
important for an aging population, where the emphasis is not on a
particular disease, but functional limitations, disability, and
increased health care use associated with disease.

The linkages between individual lifestyle behaviors and health
outcomes have been well documented. The above reports and many
others tell us, for example, that insufficient physical activity
increases the risk of developing diabetes, depression, and colon
cancer; that tobacco use affects the severity and course of asthma,
both in the tobacco user and in the passive smoker; and that excess
alcohol use contributes to oral and liver cancer, HIV risk,
arthritis, stroke, and violence.  Even more disturbing are findings
which demonstrate that these behaviors have synergic adverse
effects: for example,  while there is a 5-fold increase in oral
cancers associated with heavy alcohol use, and a 7-fold increase
associated with heavy use of tobacco, combined heavy uses of
alcohol and tobacco are known to cause a more than 30 fold increase
in attributable risk of oral cancers.  Yet while many of these
linkages between lifestyles and health outcomes have become common
knowledge, knowledge alone has not been found sufficient to induce
desired and lasting behavior change.

Further, research has shown us that health behaviors are
interrelated.  For example, studies show that women have more
difficulty than men in quitting smoking, and that women who succeed
in quitting gain more weight than men who quit.  Since smoking and
excess weight have both been demonstrated to relate to outcomes
such as heart disease, even a successful intervention that targets
tobacco use alone may not be sufficient to improve the overall
health of women.  Findings such as these suggest the need for
interventions that can successfully address multiple risk behaviors
simultaneously.

Although a variety of theoretical models (health belief model,
theory of reasoned action, prospect theory, trans-theoretical model
and stages of change, theory of planned behavior, transactional
model of stress and coping, social cognitive theory, social network
and social support, patient -provider communication, etc.) have
been developed to describe the process of health behavior change,
their potential has not been fully exploited for guiding the design
of behavioral interventions.  This RFA acknowledges that progress
could be accelerated significantly by building on fundamental
research of the behavioral sciences.  Therefore, investigation of
the utility of such theoretical models remains an important
challenge.

It is also clear that relapse rates are very high for addictive
behaviors such as tobacco use and alcohol abuse; for example most
individuals who stop smoking cigarettes relapse within six months. 
Adherence to exercise and diet regimens is no better, despite the
fact that initial success rates for various behavior change
programs are very good.  Thus long-term behavior change has become
as challenging, if not more so, than the initiation of behavior
change.  Here, too, progress may be accelerated by application of
appropriate theories of the behavioral sciences.

This RFA, coordinated under the auspices of the NIH Office of
Behavioral and Social Sciences Research (OBSSR), is a joint effort
of several Institutes and Offices of the NIH, including the NIH
Office of Disease Prevention (ODP), the NIH Office of Research on
Women's Health (ORWH), the NIH Office of Alternative Medicine
(OAM), the NIH Office of Dietary Supplements (ODS), the National
Cancer Institute (NCI), the National Heart, Lung, and Blood
Institute (NHLBI), the National Institute on Aging (NIA), the
National Institute on Alcohol Abuse and Alcoholism (NIAAA), the
National Institute of Allergy and Infectious Diseases (NIAID), the
National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS), the National Institute of Child Health and Human
Development (NICHD), the National Institute of Dental Research
(NIDR), the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK), the National Institute of Mental Health (NIMH),
the National Institute of Neurological Disorders and Stroke
(NINDS), and the National Institute of Nursing Research (NINR). 
This RFA is in line with NIH's overall mission to promote the
nation's health, by increasing the scope of research on the role of
human behavior and social processes in the promotion of health and
prevention of disease.

The American Heart Association (AHA) is joining the NIH in this
initiative, because of the RFA's responsiveness to both the AHA
Expert Panel Report on Awareness versus Behavior Change, and the
AHA Expert Panel Report on Compliance.  AHA is sponsoring the semi-
annual grantee workshops associated with this RFA.

It is hoped that the spirit of collaboration which spawned this
initiative will carry forward throughout the project and beyond. 
Toward this end, researchers are encouraged, after a reasonable
period of time for primary analyses and publication, to make the
data collected as a result of this RFA readily available to future
researchers wishing to use this data at their own research site. 
This availability may be achieved by either archiving the data and
related documentation at any recognized data archive, placing the
data and documentation on a publicly available file server
maintained by the grantee organization, or supplying the data and
documentation at cost upon request.

Research Goals and Topics

This RFA encourages grants for the study of theory-based
interventions that target initiation and maintenance of behavioral
change.  Applications must propose either to compare alternative
theories related to mechanisms involved in behavior change (the
"multiple theories" option), or to assess the utility of a
particular theoretical model for changing two or more health-
related behaviors (the "multiple behaviors" option).  Behaviors
will be restricted  to those identified in the literature as among
the major causes of mortality: tobacco use, excess alcohol
consumption, poor diet, and inactivity.  A major goal of this
solicitation is to stimulate research that addresses the difficult
problems of long-term behavior change, so selected theories must be
directed toward both behavior change and maintenance of this change
over the long-term.  Partnerships between behavior change experts,
intervention specialists, and appropriate health professionals are
essential.

The examples listed below are not exhaustive; it is expected that
additional important strategies and topics will be identified by
investigators who respond to this solicitation RFA.

Studies exemplifying ways to address the "multiple theories"
option:

o  Examinations of how competing theories interrelate or complement
each other, such as studies simultaneously varying motivation
source, degree of self- efficacy, stage of change, social
reinforcement, or norms;

o  Examinations of the increased predictive power of multiple
theories versus a single theory;

o  Collaborations between investigators with different theoretical
orientations to design head-to-head comparisons of the utility of
different theoretical models, such as comparisons of theories with
respect to their success in initiating positive behaviors
(exercise, dietary change) versus extinguishing negative behaviors
(smoking, drinking); or  comparisons of different theories for
utility in maintaining behavior change over time;

o  Investigations of the relevance of different theories for
changing particular behaviors in various underserved or high-
risk/special need populations across the life-course, with respect
to the effectiveness of different theory based interventions for
potentially vulnerable population groups (e.g., ethnic or minority
populations; low income or education; the young or the very old);

o  Investigations comparing different theoretical approaches for
integrating multiple risk messages; for example, comparing a
general intervention targeted toward multiple behavior outcomes
("healthy life style" promotion) to an intervention targeting a
single behavior and assessing its effectiveness in generalizing to
other risk behaviors.

Studies exemplifying ways to address the "multiple behaviors"
option:

o  Examinations of universal (primary) preventive interventions
that target all members of the community and all behaviors of
interest;

o  Investigations of selective or indicated (secondary or tertiary)
preventive interventions that recruit individuals on the basis of
selected behaviors; multiple risk factors or behaviors of interest
co-occur within the individual;

o  Studies containing subcomponents that address different
behaviors separately, e.g., a project with multiple substudies that
investigate different aspects of a theory for their relevance to
different behaviors;

o  Examinations of how behaviors cluster and reinforce each other,
in terms of the effects of these interrelationships on response to
different interventions (e.g., comparing intervention response of
people who engage in multiple behaviors to those who engage in a
single risk behavior; gateway behaviors for different age groups;
transfer of behavior skills from one behavior to another).

SPECIAL REQUIREMENTS

It is anticipated that a successful grant application will contain
the following key elements:

Characteristics of Interventions

Interventions should be effectiveness trials in real world settings
(e.g., clinic, workplace, club, church). While important,
community-level interventions (e.g., studies of community-based
regulatory or policy changes) will not be supported under this
initiative.  There must be explicit attention to specifying the
nature of the proposed intervention, in terms of, for example, its
intensity, duration, and frequency of contact.  Plans for assuring
treatment fidelity and implementation must also be specified. 
Applications must explain how the design will handle external
factors that can affect intervention implementation and success. 
Involvement of a community advisory panel and/or partnership with
a non-academic community or health organization may be helpful in
devising strategies to enhance intervention design, implementation,
outreach, and interpretation of findings.

Bi-Annual Meetings and Collaboration

Applicants must plan for conference calls four times a year among
grantees supported as a result of the RFA, to coordinate research
and share progress.  In addition, application budgets must include
funds to attend two collaborative meetings to be held in the
Washington DC area, for three investigators from each site per
year.  The first collaborative meeting will occur shortly after
grant award, and will focus on research designs, objectives, and
possible collaborative arrangements that might foster increased
productivity or efficiency in addressing the objectives proposed by
the applicants.  It is desirable to achieve some uniformity in
measurement of key behaviors across the different funded sites. 
Therefore, investigators will be asked to bring their strategies
for measuring exercise, smoking, diet and alcohol abuse to the
first meeting, and an attempt will be made to identify a common
core of key measures.  After the completion of the four-year
project period, NIH may invite the grant recipients to participate
in a symposium to evaluate the findings and their implications for
research and policy.

Plans for Long-Term Follow- Up

While initial follow-up plans may be limited by the four-year
duration of this program, experimental designs must provide for at
least one year follow-up in the initial grant, and propose plans
for the possibility of extended follow-up with funding sought by
competition through traditional investigator-initiated mechanisms,
for successful or promising research projects. For example,
provision should be made for maintaining contact with participants,
structuring informed consent as appropriate, age of participants,
or data collection.  Methods must have the capacity to assess
maintenance of change and confounding variables (e.g., multiple
versus single risk behaviors).

Pilot Data

Preference will be given to applications with pilot data, or with
experience in testing the feasibility of recruiting diverse
populations, designing theory-based interventions, and assessing
their outcomes.  Given the call for research on multiple behaviors
or intervention strategies, applicants may not have pilot work in
all aspects of their proposed work.  However, they are expected to
show the relevance of their previous work to the current effort. 
Additional pilot work on refining the intervention and assessment
protocol may occur in the first year, but since recruitment accrual
and intervention time-frames must permit at least one year of
follow-up assessment, all sites must plan to enter the field with
finalized interventions and assessments by the start of the second
year.

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 the Public Service Act, added by 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 has been
published in the Federal Register of March 28, 1994 (FR 59
14508-14513), and in the NIH GUIDE FOR GRANTS AND CONTRACTS of
March 18, 1994, Volume 23, Number 11.

Investigators may obtain copies from these sources of from the
program staff or contact the person listed below.  Program staff
may also provide additional relevant information concerning the
policy.

LETTER OF INTENT

Prospective applicants are asked to submit, by April 1, 1998, a
letter of intent that includes a descriptive title of the proposed
research the name, title, institution, and e-mail address of the
principal investigator, and identification of any other
participating institutions.  Such letters are requested only for
the purpose of facilitating technical assistance and review, by
providing an indication of the number and scope of applications to
be received; consequently, their receipt is usually not
acknowledged.  A letter of intent is not binding, and it will not
enter into the review of any application subsequently submitted,
nor is it necessary to have sent a letter of intent to submit an
application.

The letter of intent is to be sent to:

Susan D. Solomon, Ph.D.
Office of Behavioral and Social Sciences Research
National Institutes of Health
7550 Wisconsin Avenue, Room 8C16, MSC 9172
Bethesda, MD  20892
FAX:  (301) 480-8905
Email:  ssolomon@nih.gov

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 5/95) is to be
used in applying for these grants.  Applications kits are available
at most institutional offices of sponsored research and maybe
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: 
ASKNIH@od.nih.gov.

To identify the application as a response to this RFA, the RFA
title "Innovative Approaches to Disease Prevention through Behavior
Change," and number "OD-98-002," must be typed under item 2 of the
face page of the application form, and the YES box must be checked. 
The RFA label available in the PHS 398 application kit must be
affixed to the bottom of the face page of the original copy of the
application. Failure to use this label could result in delayed
processing the application such that it may not reach the review
committee in time for review.

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

CENTER FOR SCIENTIFIC REVIEW (formerly Division of Research Grants)
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

At time of submission, an additional copy of the application must
also be sent under separate cover to:

Susan D. Solomon, Ph.D.
Office of Behavioral and Social Sciences Research
National Institutes of Health
7550 Wisconsin Avenue, Room 8C16, MSC 9172
Bethesda, MD  20892

All applicants must provide a Protection of Human Subjects
Assurance  Identification/Certification/Declaration as specified in
the policy described on the Optional Form 310.  If there is a
question regarding the applicability of this assurance, contact the
Office for Protection from Research Risks of the National
Institutes of Health at (301) 496-7041.

Applications must be received by May 21, 1998.  If an application
is received after that date, it will be returned to the applicant. 
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 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 previously reviewed, but such applications must
include an introduction addressing the previous critique.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness by
CSR, and for responsiveness by the NIH program staff.  Incomplete
applications will be returned to the applicant without further
consideration.  In addition, if program staff find that the
application is not responsive to the RFA, it will be returned to
the applicant without review.

Applications that are complete and responsive to the RFA will be
evaluated for scientific and technical merit by a special emphasis
panel convened in accordance with NIH peer review procedures.  As
part of the initial merit review, all applications will receive a
written critique and undergo a process in which only those
applications deemed to have the highest scientific merit, generally
the top half of applications under review, will be discussed, and
assigned a priority score; those with the potential for funding
will receive a second level review by the National Advisory Council
of the relevant NIH institute.

Applications will be judged on the following criteria:

(1) Significance: Does the application propose either to compare
alternative theories related to mechanisms involved in behavior
change, or to assess the utility of a particular theoretical model
for changing two or more of the following health-related behaviors:
(smoking, drinking, poor diet, inactivity)? Does the research
address both behavior change and maintenance of this change over
the long-term?  If the aims of the application  are achieved, how
will scientific knowledge be advanced?  What will be the effect of
these studies on the concepts or methods that drive this field?

(2) Approach: Are the conceptual framework, design, methods, and
analyses adequately  developed, and appropriate to the aims of the
project?  Are the conceptual models well integrated into the design
and testing of the proposed intervention? Will the intervention
take place in a real world setting? Has sufficient detail about the
intervention been provided to understand the intervention processes
and mechanisms of change? Does the applicant  acknowledge potential
problem areas and consider alternative tactics? Have provisions
been made for the possibility of extended follow-up, including
methods capable of assessing maintenance of change and confounding
variables?

(3) Innovation: Does the project employ novel concepts, approaches
or method? Are the aims original and innovative? Does the
intervention effort go beyond previous single behavior/intervention
approaches?

(4) Investigator:  Is the investigator appropriately trained and
well suited to carry out this work?  Is the work proposed
appropriate to the experience level of the principal investigator
and other researchers (if any)? Is there provision for partnerships
between behavior change experts, intervention specialists, and
appropriate health professionals?

(5) Environment:  Does the scientific environment in which the work
will be done contribute to the probability of success?  Does the
proposed experiment take advantage of unique features of the
scientific and community environment, or employ useful
collaborative arrangements?  Is there evidence of institutional
support?

Receipt and Review Schedule

Letter of Intent Receipt Date:  April 1, 1998
Application Receipt Date:       May 21, 1998
Initial Review:                 September/October 1998
Advisory Council Review:        January 1999
Earliest Start Date:            April 1, 1999

AWARD CRITERIA

Funding decisions will made by the sponsoring organizations, based
on scientific and technical merit as determined by peer review,
program priorities, content area balance, practice relevance, and
the availability of funds.

INQUIRIES

Inquiries concerning this RFA are encouraged.  The opportunity to
clarify any issues or questions from potential applicants is
welcome.  Program staff of the NIH are available for consultation
concerning application development before or during the process of
preparing an application.  Potential applicants should contact
program staff as early as possible for information and assistance
in initiating the application process and developing an
application.

General inquiries (e-mail preferred) regarding process may be
directed to:

Susan D. Solomon, Ph.D.
Office of Behavioral and Social Sciences Research
National Institutes of Health
7550 Wisconsin Avenue, Room 8C16, MSC 9172
Bethesda, MD  20892
Telephone:  (301) 496-0979
FAX:  (301) 480-8905
Email:  ssolomon@nih.gov

Substantive inquiries (e-mail preferred) regarding content, design,
and application development, including whether a particular
research topic falls within the scope of the RFA, may be directed
to:

Patricia Bryant, Ph.D.
National Institute of Dental Research
45 Center Drive, Room 4AN24E - MSC 6402
Bethesda MD  20892
Telephone:  (301) 594-2095
FAX:  (301) 480-8318
Email:  bryantp@de45.nidr.nih.gov

Tom Glynn, Ph.D.
National Cancer Institute
6130 Executive Plaza Boulevard, Room 211
Rockville, MD  20852
Telephone:  (301) 496-8520
FAX:  (301) 496-8675
Email:  tom_glynn@nih.gov

Peter G. Kaufmann, Ph.D.
National Heart, Blood, and Lung Institute
6701 Rockledge Drive MSC 7936
Bethesda, MD  20892-7936
Telephone:  (301) 435-0404
FAX:  (301) 480-1773
Email:  kaufmanp@gwgate.nhlbi.nih.gov

June R. Lunney, Ph.D., RN
National Institute of Nursing Research
Building 45, Room 3AN-12
Bethesda, MD  20892-6300
Telephone:  (301) 594-6908
FAX:  (301) 480-8260
Email:  JLunney@EP.NINR.NIH.GOV

Marcia G. Ory, Ph.D., M.P.H.
National Institute on Aging
Gateway Building, Room 533
Bethesda, MD  20898
Telephone:  (301) 402-4156
FAX:  (301) 402-0051
Email:  marcia_ory@nih.gov

Direct inquiries regarding fiscal matters to:

Christopher Robey
National Heart, Lung, and Blood Institute
6701 Rockledge Drive  MSC 7926
Bethesda, MD  20892-7926
Telephone:  (301) 435-0166
FAX:  (301) 480-3310
Email:  RobeyJ@gwgate.nhlbi.nih.gov

David Reiter
National Institute on Aging
7201 Wisconsin Avenue, Room 2N212
Bethesda, MD  20892-9205
Telephone:  (301) 466-1472
FAX:  (301) 402-3672
Email:  David_Reiter@NIH.GOV

Victoria Putprush
National Institute of Allergy and Infectious Diseases
Solar Building, Room 4B29
Bethesda, MD  20892-7610
Telephone:  (301) 402-6245
FAX:  (301) 480-3780
Email:  vp8g@nih.gov

Jeff Carow
Grants Management Officer
National Institute of Nursing Research
45 Center Drive, Room 3AN-12 - MSC 6301
Bethesda, MD  20892-6301
Telephone:  (301) 594-6869
FAX:  (301) 480-8260
Email:  jcarow@ep.ninr.nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance Numbers 93.395 (NCI), 93.837 (NHLBI), 93.886 (NIA),
93.273 (NIAAA), 93.856, 93.855 (NIAID), 93.846 (NIAMS), 93.865
(NICHD), 93.848 (NIDDK), 93.121 (NIDR), 93.242 (NIMH), 93.853
(NINDS), and 93.361(NINR).  Awards are made under authorization of
section 301 and Title IV (42 U.S.C. 241 and 281) of the Public
Health Service Act, and are administered under PHS grants policies
and Federal Regulations 42 CAR 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.  Awards
by PHS agencies will be administered under PHS grants policy as
stated in the Public Health Service Grants Policy Statement (April
1, 1994).

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the nonuse 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, any 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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	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)