Full Text PA-95-060 DRUG AND ALCOHOL USE AND ABUSE IN RURAL AMERICA NIH GUIDE, Volume 24, Number 16, May 12, 1995 PA NUMBER: PA-95-060 P.T. Keywords: National Institute on Drug Abuse National Institute on Alcohol Abuse and Alcoholism Department of Agriculture PURPOSE The purpose of this program announcement is to encourage research on drug and alcohol use and abuse behaviors in rural America, the consequences of such use/abuse, and the delivery of appropriate prevention and treatment services. 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 program announcement, Drug and Alcohol Use and Abuse in Rural America, is primarily related to the priority area of alcohol and other drugs. 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 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by foreign and domestic, 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. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as principal investigators. Foreign institutions are not eligible for First Independent Research Support and Transition (FIRST) (R29) awards. MECHANISM OF SUPPORT Research support mechanisms include research project grants (R01), small grants (R03), and FIRST (R29) awards. Submissions as Investigator- Initiated Interactive Research Project Grants (IRPG) may also be made. For more information on the IRPG mechanism, see NIH Guide, Vol. 23, No. 28, July 29, 1994. Because the nature and scope of the research proposed in response to this program announcement may vary, it is anticipated that the size of an award will vary also. Small grants provide research support of up to $50,000 per year in direct costs plus appropriate indirect costs for up to two years. FIRST awards provide support for five years and up to $350,000 in direct costs over the entire project period. Copies of the program announcements for R03 and R29 may be obtained from program staff listed under INQUIRIES. RESEARCH OBJECTIVES Background Little research attention has been given to issues of drug and alcohol use and abuse in U.S. populations residing in rural areas. "Rural" can be defined in several ways: by distance from urban areas, by type of economic base, by density of population, and, in the case of Native American populations, by the geographic location of reservations. Rural has been defined also as a "cultural" perspective of the world as well as a normative structure. It is additionally defined by the distribution of scarce resources and services. Recent epidemiologic data, although sparse, show that rates of drug and alcohol use and abuse in rural areas vary, depending on the demographics of the area. They can be quite low or high relative to rates measured in the inner areas of large cities. More systematic measures of these rates and reasons for their variation should be the focus of further investigation. The etiology of drug and alcohol abuse in rural populations also requires study. Researchers believe that declining economic opportunities in these groups are undermining family structures and dynamics, which previously served as protective factors against substance abuse. However, this hypothesis needs to be systematically tested in relevant communities. The economic impact of the 1980s on rural areas in terms of lost jobs and migration to more urban areas has depleted available resources that supported the delivery of health, mental health, and drug and alcohol abuse prevention and treatment services. However, the specific nature of current service delivery systems, how they are organized, and who they reach are topics that have not been well documented. Furthermore, opportunities for innovative delivery models may present themselves, particularly within community settings. Finally, the special needs of certain population groups within the rural setting have not been well addressed. Native Americans, migrant workers, Hispanics, and African Americans have been found to have differing patterns of drug and alcohol abuse and associated consequences and to be confronted with varying barriers to accessing prevention and treatment services. Specific studies that examine these issues and innovative service delivery models are encouraged. Program Description Three areas of research are sought through this program announcement. These areas include epidemiology/etiology and prevention and treatment services research. Examples of research areas to be addressed are provided below. Epidemiology/Etiology o Epidemiologic descriptions of patterns of drug and alcohol abuse, of the characteristics of those who evidence these patterns, and of the social/economic/environmental context associated with prevalence and incidence patterns. Especially encouraged is building upon existing epidemiologic systems such as the NIDA-sponsored Community Epidemiology Work Group (CEWG). Additionally, special attention is encouraged on the impact of both in- and out-migration in rural areas. o Documentation of the health (specifically HIV and AIDS, tuberculosis, and sexually-transmitted diseases), social-legal, and economic consequences of drug and alcohol abuse. o Identification of the processes associated with initiating drug and alcohol use and progression to abuse/dependence, including periods of discontinuation and the factors that are associated with this progression and/or discontinuation. Special emphasis should be given to determining protective factors (processes) that prevent or interrupt progression with a focus on community-family factors that promote or protect against such consequences. o Specification of varying use and abuse patterns for different cultural, ethnic, gender, generational, and occupational subgroups within rural populations (e.g., farmers, fishermen, miners, lumbermen, blue and white collar manufacturing and service personnel). Drug and Alcohol Abuse Intervention for Prevention and Treatment of Services Research o Development and testing of innovative multi-strategy, comprehensive prevention and/or treatment interventions that are community-based. o Development and testing of single-channel prevention strategies such as media, worksite, family-based, or school-based approaches. o Evaluation of existing prevention/intervention and treatment services being delivered to rural populations. Both quantitative and ethnographic research approaches are encouraged where appropriate, including studies of special subpopulations such as those living in economically depressed communities (e.g., Appalachia and mobile communities such as migrant farm workers). o Assessments of the impact of prevention/intervention and/or treatment strategies or service delivery at the community, state, regional, or national level, including the effects of specific laws or regulations such as controls on the availability of alcohol. o Assessment of outreach strategies to expand prevention and treatment intervention and/or services to underserved populations in rural areas. o Research on methods for diffusion of innovative clinical practices and management techniques to improve prevention/intervention and treatment services and lower program costs. o Research on consumer choice, prevention/treatment program selection, and service retention resulting from existing or innovative practices. o Research to integrate drug and alcohol abuse prevention approaches with interventions directed at other related behavioral and societal problems such as violence, teenage pregnancy, school dropouts, domestic abuse, HIV and STDs. o Prevention intervention research for preschool and elementary students with possible drug and alcohol induced learning disorders. o The operation and impact of financing mechanisms relating to substance abuse treatment should be studied, particularly in sparsely populated areas. Adequacy of coverage in rural states, under private coverage and medicaid, and how rural providers utilize such mechanisms is of particular interest. o The organization of prevention and treatment services may be problematic in rural areas, affecting access and utilization as a function of population density and economic factors. Patterns of utilization, organization of services, and how linkages between primary care and drug abuse services affect utilization, quality of care, and outcomes. o Management of care in health systems in rural areas is of interest. How are managed care systems organized, and what are the consequences in terms of decision processes, adequacy, quality, and appropriateness of services, continuity and integration of services, and outcomes. What case management models are evident and how is managed care used to link services? Acknowledgement of funding for research from either or both Institutes and from the United States Department of Agriculture (when it has been determined through discussions between the applicant and one or both Institutes that Agriculture funds have been allocated to the Institutes and are being used to help fund applicant's grant) must be given on all published and unpublished reports. It is also desirable to credit the two Institutes and Agriculture for relevant technical assistance provided during the course of the grant. 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 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 new 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 14508-14513), and reprinted in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume 23, Number 11. Investigators may obtain copies from these sources or from the program staff or contact person listed below. Program staff may also provide additional relevant information concerning the policy. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard receipt dates indicated in the application kit. Application kits are available at most institutional offices of sponsored research and may be obtained from the Office of Grants Information, Division of Research Grants, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892, telephone 301/710-0267. The title and number of the program announcement must be typed in Section 2a on the face page of the application. FIRST (R29) award applicants must include at least three sealed letters of reference attached to the face page of the original application. FIRST applications submitted without the required number of reference letters will be considered incomplete and will be returned without review. The completed original application and five legible copies must be sent or delivered to: Division of Research Grants National Institutes of Health 6701 Rockledge Drive, Room 1040 - MSC 7710 Bethesda, MD 20892-7710* Bethesda, MD 20817 (for overnight/express service) REVIEW CONSIDERATIONS Applications that are complete and responsive to the program announcement will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with the standard 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, assigned a priority score, and receive a second level review by the appropriate national advisory council or board. Review Criteria o Scientific or technical significance and originality of the proposed research; o Appropriateness and adequacy of the research approach and methodology proposed to carry out the research; o Qualifications and research experience of the principal investigator and staff; o Availability of resources necessary to the research; o Appropriateness of the proposed budget and duration in relation to the proposed research; and o Adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. The initial review group will also examine the provisions for the protection of human and animal subjects, and safety of the research environment. AWARD CRITERIA Applications will compete for available funds with all other approved applications. The following will be considered in making funding decisions: quality of the proposed project as determined by the peer review, availability of funds, and program priority. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries on the scientific and programmatic aspects to: Peter Hartsock, Dr. P.H. Division of Epidemiology and Prevention Research National Institute on Drug Abuse 5600 Fishers Lane, Room 9A-53 Rockville, MD 20857 Telephone: (301) 443-6720 FAX: (301) 443-2636 Email: ph45z@nih.gov Gayle Boyd, Ph.D. Division of Clinical and Prevention Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 505 Bethesda, MD 20892-7003 Telephone: (301) 443-8766 FAX: (301) 443-8774 Email: gboyd@willco.niaaa.nih.gov Elizabeth Robertson, Ph.D. U.S. Department of Agriculture Agriculture Research Service Unit No. 83 Riverdale, MD 20737 Telephone: (301) 734-8596 Email: erobertson@assrr.ars45da.gov Direct inquiries regarding fiscal matters related to drug abuse relevant studies to: Dr. Gary Fleming Chief, Grants Management Branch 5600 Fishers Lane, Room 8A-54 Rockville, MD 20857 Telephone: (301) 443-6710 FAX: (301) 443-6487 Email: gfleming@aoada2.ssw.dhhs.gov Direct inquiries regarding fiscal matters related to alcohol abuse relevant studies to: Mr. Joseph Weeda Chief, Grants Management Branch National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 504 Rockville, MD 20892 Telephone: (301) 443-4703 FAX: (301) 443-3891 Email: jweeda@willco.niaaa.nih.gov AUTHORITIES AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.279 and 93.273. Awards are made under authorization of the Public Health Service Act, Section 301, and administered under PHS policies and Federal Regulations at 42 CFR 52 and 45 CFR Part 74. The United States Department of Agriculture has transferred funds under authorization of the Food, Agriculture, Conservation and Trade Act of 1990, PL 101-624, Section 1602(a) (7 USC 1421) and, the National Agriculture Research, Extension and Teaching Policy Act of 1977 as Amended, Section 1402 (7 USC 3101). This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Grants must be administered in accordance with the Public Health Service Grants Policy Statement (DHHS Publication No. (OASH) 82-50-000 GPO 0017-020-0090-1 (rev. 4/94). 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, any portion of a facility) in which regular or routing 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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