Full Text PA-95-061 WOMEN'S MENTAL HEALTH RESEARCH NIH GUIDE, Volume 24, Number 16, May 12, 1995 PA NUMBER: PA-95-061 P.T. Keywords: National Institute of Mental Health PURPOSE The National Institute of Mental Health (NIMH) invites grant applications from investigators for research on mental disorders, symptoms, and behavioral, cognitive and social concerns in women across the lifespan. Research on women's mental health includes individual differences in normative behavior, the epidemiology of specific mental disorders, the etiology and risk factors for their development; study of the natural and treated course of illness; prevention; intervention strategies including pharmacokinetics, pharmacodynamics, efficacy of medications, and psychosocial interventions; studies of the efficacy and effectiveness of various prevention and treatment modalities and service use. The NIMH encourages research on underserved populations: minority, rural, and homeless women and women who are at risk for HIV, who are HIV positive, and who have AIDS. This program announcement (PA) complements the existing PA, Women's Health Over the Lifecourse: Social and Behavioral Aspects (PA-92-105), by adding the broad coverage of biologic, pharmacologic, and prevention, treatment, and services issues and includes earlier developmental periods within its scope. 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 health priority areas. This program announcement, Women's Mental Health Research, is related to the priority areas of women's health, mental health, and mental disorders. 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. Foreign institutions are not eligible for small grants (R03s), First Independent Research Support and Transition (FIRST) (R29s) awards, and program project (P01) grants. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT The mechanisms of support will be the investigator-initiated research project grant (R01), FIRST award (R29), and small grant (R03). To apply for support of a more broadly based multidisciplinary research program, the research program project (P01) mechanism is suggested. Policies that govern the research grants programs of the NIH will prevail. Details of eligibility for the different funding mechanisms vary. Applicants are strongly advised to contact the program official listed under INQUIRIES for additional information, particularly related to P01s and other specific application procedures. RESEARCH OBJECTIVES Mental disorders can be recurring or chronic, debilitating, and life-threatening. Although no gender difference in the prevalence of total mental disorders was reported in the NIMH Epidemiologic Catchment Area study, higher rates for affective and anxiety disorders were found among women; for example, major depression and dysthymia affect almost twice as many women as men. Among disorders in which there are similar prevalence rates for men and women, gender differences may be apparent in symptomatology, age of onset, course of illness, and response to treatment. Epidemiologic surveys indicate that women are prescribed and use psychotropic medication at twice the rate of men, yet large gaps remain in the knowledge base of gender differences in pharmacology. Historically, this difference is due, in part, to the exclusion of women of childbearing age from drug-development trials because of fear of unintended birth defects. In addition, men have been considered less complicated research participants because their levels of sex hormones were assumed to remain relatively constant, thus reducing the chance of confounding results. By excluding women, researchers have not had to concern themselves with questions about the effects of the menstrual cycle, or whether the women were pre-, peri-, or post-menopausal or on hormone medications (e.g., oral contraceptives or estrogen replacement therapy). Unfortunately, this research strategy has not furthered the understanding of gender differences in pharmacokinetics and pharmacodynamics of psychotherapeutic drugs. There are several cross-cutting issues pertinent to many of the special topic areas described in this PA. One is developmental stage. Gender differences in age of onset (e.g., schizophrenia) or age-related differences in course of mental disorders (bipolar depression) suggest the importance of life stage in the study of women's mental health and, therefore, the need for both basic and applied research related to women's mental health across the life course. Attention to differences in developmental trajectories within biological (e.g., pubertal stage, menopausal status) and/or psychosocial contexts (e.g., rural and urban environments, poverty, educational status, peer and marital status, history of abuse) is necessary in research that considers either gender differences in mental disorder or variation among females. A second cross-cutting issue relevant to women's mental health research is limited information available on ethnic minority females. Knowledge about ethnic minority women's mental health is even more limited in terms of understanding the etiology and prevalence of mental disorders, the clinical course, intervention effectiveness, and service use related to these disorders. The meaning of ethnic identity as it pertains to acculturation, social class, and sex-role socialization requires careful refinement when considering associations with psychopathology. Differences in response to high blood pressure medications among men of different ethnic groups suggest that there may be possible differences in the pharmacokinetics and pharmacodynamics of psychotherapeutic drugs among ethnic groups of women. Comorbidity, a third cross-cutting issue, is not unique to women's mental health but reflects current understanding of the etiology and course of mental disorders. Increasing evidence indicates a high likelihood of finding comorbidity among mental disorders, and comorbidity between mental disorder and substance abuse, developmental disability, physical disorder, as well as stress, violence, or other traumas. Lifetime comorbidity (past history of mental, physical, and substance abuse disorders and/or history of trauma or stress) is also of interest in terms of how it may predispose individuals to certain patterns of disorder over the life course. The genetics of mental disorders constitutes a fourth cross-cutting area relevant to the mental health of women. Gender differences in prevalence rates, onset, and symptom patterns of many mental disorders have led to a variety of biological theories based at least partially on genetics: genetic effects of X-linkage, genetic imprinting, and mitochondrial inheritance of susceptibility genes. Other explanations proposed include sex differences in the inheritance of subclinical susceptibility traits or other phenotypes which may predispose to the development of psychiatric disorders and to the possible interactions between such genetic factors and other neuroendocrine factors that are gender specific. Genetic epidemiology may help to identify genetic and environmental factors contributing to mental disorders and suggest promising prevention strategies. Special Topic Areas The following topics highlight research areas needing attention. They are only illustrative of current research questions and are not intended to limit in any way the exploration of many underresearched topics in women's mental health. Basic Research. Research that ascertains the relative contributions of environmental and biological factors to individual differences in normal behavior is required to understand the etiology of gender-based differences in prevalence and age of onset of psychopathology and to shape effective prevention and treatment. Needed studies include: o sexual dimorphism in the cerebral cortex and the mechanisms regulating developmental events that lead to differences; methodological approaches to these issues including pharmacological, physiological, anatomical, functional neuroimaging, molecular, or genetic techniques o mechanisms underlying regulatory behaviors that may be sexually differentiated, such as ingestion, aggression, exploration, sleep and chronobiology o the nature and development of gender differences in cognition, including interaction with motivation, stress, emotional reactivity and regulation, personality, and social interaction o the nature and development of gender role, gender identity, and sexual orientation across the lifespan, with consideration of both biological and environmental influences o ways in which variation in spousal, parental, sibling, peer, and extra-familial interactions contribute to gender- related risk and protective factors o the impact of women's work force and welfare participation on parent-child, marital, and overall family adjustment o the differential effect of stressors on women, including sociocultural stressors (e.g., racially, ethnically, or sexually based discrimination), socioeconomic stressors (e.g., poverty), and interpersonal stressors (e.g., marital dissolution, conflict between work force and family obligations). Epidemiology and Psychopathology. Studies employing epidemiologic designs have contributed much of what we know about population-based rates of the incidence, prevalence, and risk factors for mental disorders in females. Further research is needed on: o factors associated with gender differences in prevalence rates of various mental disorders in community-defined populations o the risk factors for the onset of specific mental disorders in females at various points in the lifespan, including biological factors, childhood behavioral/emotional problems, physical illness, societal-level factors o existing data sets such as the Epidemiologic Catchment Area studies, National Comorbidity Survey, and the Health and Nutrition Surveys, to further explore how risk factors may uniquely affect men and women o cohort effects that may have differential influence on the prevalence rates of mental disorders for males and females o gender differences in rates of suicide attempts and completions and their risk factors o rates of comorbidity in females, including Axis I mental disorders with addictive disorders and with Axis II disorders, and the factors associated with comorbidity in the community o genetic epidemiologic approaches to studying mental disorders in females, including gene-environment interaction models, family studies, and population-based linkage studies o assessment of reliability and validity of current diagnostic classification systems and instruments in female populations, including ethnic and racial subpopulations. Mood, Anxiety, and Personality Disorders. Mood disorders affect almost twice as many women as men. Panic disorder and phobias also affect two to three times as many women as men. Clinical studies are needed on: o the development and course of mood, anxiety, and personality disorders that have significant gender differences in prevalence, including the exploration of possibly distinct subtypes o the biological and psychosocial gender-related variables related to the development, onset (including childhood), course, treatment, and relapse of mood and anxiety disorders o gender differences in cognitive and/or personality variables as they predispose to onset or recurrence of disorders o the role of gender in suicide attempts and completions across the life course, including psychological and biological factors o gender differences in grief reactions and depression following bereavement o gender differences in the development of phobic avoidance for social and specific phobias and agoraphobia o the role of genetic factors in gender differences in mood, anxiety, and personality disorders o gender differences in somatization disorder as related to affective and anxiety disorders o gender differences in etiology and symptoms in dissociative disorder with regard to early developmental history, including sexual and physical abuse o the role of shared and distinctive genetic and environmental factors in patterns of comorbidity between Axis I and Axis II disorders in women. Psychiatric Disorders and Reproductive Health. Differences between male and female reproductive systems are often correlated with gender differences in rates of affective disorder. Changes in women's reproductive systems are also purported to account for differences in mood disorders among women. Research is needed on: o the role of menarche in onset and course of mental disorders o the role of menstrual cycle variables in the onset and maintenance of chronic depression, or in the exacerbation of an existing episode; the relationship between premenstrual depressive disorder and prior psychopathology o the clinical significance of variables related to prepubertal, menstrual cycle, and menopausal status in biological studies of psychopathology and pharmacological treatment studies o the spectrum of postpartum mood changes, including psychotic disorders, nonpsychotic depression, and transient blues with implications for the development of efficacious and safe treatments o the relation between endocrine and social changes of the postpartum period, including that of women with individual and/or family histories of mood disorder o the interactions among the hypothalamic pituitary adrenal and thyroid axes and gonadal steroids in pre- and post- menopausal women, and the relation of these hormonal interactions to susceptibility to psychiatric disorders o mood disorder in the perimenopause and menopause, especially in relation to prior history of disorder, psychosocial stressors, somatic symptoms of menopause, and estrogen replacement treatments (ERT) o the long-term effects of chronic ERT use on the onset and course of mental disorders in later life such as dementia, depression, and anxiety o potential nonpharmacological somatic treatments, such as light therapy, which may be effective for the treatment of behavioral and physiological symptoms of perimenopause o the development of psychiatric disorders secondary to gynecologic illnesses (e.g., pelvic inflammatory disease), medical procedures (e.g., genetic counseling, oophorectomy, breast cancer, and other treatments), miscarriage, treatments, and outcomes (e.g., infertility) o the effects of reproductive disorders on the psychological status of patients' daughters and other family members. Eating Disorders. Eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, are more common among young women compared to older women or males in clinic population groups. Research is needed on: o the community incidence and prevalence of eating disorders and their comorbidity with physical, mental, and substance abuse disorders o etiologic factors including psychosocial, biologic, and genetic risks o course of illness and long-term impact of psychosocial and pharmacologic treatments o impact of comorbidity on etiology and treatment response. Alzheimer's Disease and Related Dementias (AD). Women outnumber men with increasing age, and risk of dementia increases with age. Older women (aged 85+) have a one in four chance of being diagnosed with AD on average. Further study is needed on: o gender-related risk and protective factors for AD, including the potential protective effect of estrogen replacement therapy o the relation between late onset depression and dementia o factors that place middle-aged and older women caregivers of family members with AD at risk for depression and exacerbated physical disorders (e.g., compromised immune functioning, cardiovascular disease) o improvement of quality of life among women in nursing homes, where depression has been associated with greater morbidity and mortality. Schizophrenia. Persons with an early adulthood onset of schizophrenia are more likely to be male, while late-onset (aged 45+) schizophrenia occurs more frequently among females. In addition to studying the gender-by-age effects on onset patterns, more research is needed on: o gender differences in the development, clinical course, and symptoms of schizophrenia, and response to treatment with antipsychotic medications and psychosocial rehabilitation therapies and long-term outcomes o the possible role of estrogen in modulating gender differences in symptoms and medication side effects, such as tardive dyskinesia o gender differences in cerebral and limbic system brain morphology detectable by postmortem and brain imaging techniques o gender differences in suicide attempts and completions among persons with schizophrenia, and clinical profiles of attempters and completers. AIDS and Other Sexually Transmitted Diseases (STDs). The incidence of HIV in women is increasing at a rate four times that of men in this country. AIDS is the leading cause of death among women between ages 25 and 44. African-American women face between 10 and 15 times the risk of AIDS compared with White women. Studies are needed on: o the use of both qualitative and quantitative methods to better describe women who are at risk for HIV infection or who are seropositive in order to develop successful, cost-effective prevention and treatment efforts o relation of the HIV stigma among women to: coping, their potential role as health educator and health caretaker in the family, family awareness of HIV and provision of support, mental health consequences, and use of services o the individual and family factors that contribute to high-risk sexual behavior in adolescent girls o the acceptance and implementation of effective female- controlled methods of reducing or preventing STDs or HIV o the prevalence of comorbid STDs with chronic mental illness, personality disorders, mood and anxiety disorders, and past sexual abuse o the way infected women make decisions about reproductive options, place children in caretaking contexts, and prepare for their own deaths and/or their children's deaths. Comorbidity with Physical Illness. Little is known about the gender differences in psychiatric comorbidity with physical illnesses; further, testing for and identification of risk for physical illness (e.g., genetic testing for breast cancer) as well as the diagnosis and treatment of physical illness may have unique, adverse behavioral and psychological consequences for women. Research is needed on the gender differences in: o psychiatric comorbidity with physical illness and how to best develop appropriate interventions o behavioral and psychological risks of genetic testing and disease diagnosis and the development of gender-appropriate counseling and educational procedures to reduce adverse consequences o the adverse behavioral and psychological consequences of treatments for physical illness and methods for reducing such consequences. Sleep. The consequences of sleep disorders, sleep deprivation, and sleepiness include reduced productivity, lowered cognitive performance, increased likelihood of accidents, higher morbidity and mortality, and decreased quality of life. Although sleep problems in women are markedly different from those found in men, little attention has been paid to the assessment of gender differences. Research is needed on: o effects of the menstrual cycle, pregnancy, the postpartum period, and menopause on sleep o reasons for the increase in insomnia in women over 40 o role of sleep problems in the etiology, clinical course, and treatment of psychiatric disorders among adolescent girls and women o consequences of sleep deprivation resulting from various combinations of working outside the home, childcare, and caring for elderly parents. Violence and Abuse of Women and Girls, Rape, Sexual Assault, Domestic Violence. Females disproportionately suffer from domestic violence, rape, and physical and sexual abuse. For example, girls are two to three times more likely than boys to be sexually abused. Research is needed on: o the psychosocial and biological effects of violence and trauma on developmental trajectories (with consideration of age of puberty), on later interpersonal relationships (including marital interactions, parenting behavior), and on mental health outcomes (including post-traumatic stress disorder, depression, anxiety) o effective psychosocial and pharmacologic treatment strategies for victims of violence and abuse o the prevalence of abuse of elderly women, probable risk factors, and promising prevention and intervention strategies o the impact of violence on the frequency and nature of seeking health and mental health care-related services (e.g., increased use of medical emergency room services by women who have been exposed to violence and trauma) o the prevalence of victimization among severely mentally ill women o the appropriate recognition and diagnosis of trauma-related problems by health and mental health treatment providers. Prevention Research. Preventive interventions precede clinical diagnosis and the need for treatment and are aimed at reducing new cases of mental disorders and related problems. Promotive interventions are aimed at a demonstrable development, maintenance, or enhancement of healthy psychosocial functioning. Included are initial tests of efficacy and subsequent tests of the effectiveness of promising intervention strategies in defined population trials. Of particular interest are studies on: o gender-specific effects of preventive and promotive interventions aimed at individuals or groups at high risk for depressive and/or anxiety disorders and related affective problems o intervention effects on constellations of risk and protective factors that may be of particular relevance to the etiology and development of depression/anxiety in women and girls, including biological, cultural, and psychosocial factors o interventions that target the mental health effects of multiple role strains experienced by women, including those who are single parents, who work outside the home, or take care of older and younger generations simultaneously o interventions for women who are at high risk for postpartum depression, for depression related to loss of a loved one, or for depression associated with other life events o interventions that are aimed at multiple, comorbid outcomes in women at risk, including mental and substance use disorders o interventions which modify gender-specific developmental pathways to conduct disorder and serious behavior problems in girls, including comorbid conditions. Treatment Efficacy. Treatment efficacy research is the study of clinical trials of psychopharmacologic and psychosocial treatments for mental disorders. Included are the identification of psychological and biological effects and predictors of outcome. Studies are needed on: o the pharmacokinetics and pharmacodynamics of psychotropic medications, in particular, receptor populations and enzyme levels (such as gastric enzymes and hepatic P-450 induction or substrates) by gender and across age, ethnic, and cultural groups o drug-drug interactions, drug clearance in women who are concomitantly taking various estrogen preparations, and the possible modulation of responses to psychotherapeutic medications o the efficacy of psychosocial and pharmacologic interventions (singly and in combination), including estrogen replacement therapy (ERT) as adjunctive treatment for various types of depression in women in middle and later life o the gender differences in potential preferences or expectancies for treatment modalities, such as a preference for interpersonal psychotherapy, and implications for treatment efficacy o the inclusion of more refined measures of functional impairment in treatment that can be made more relevant to women and their roles, including quality of life o the implementation of more powerful quantitative techniques for modeling trajectories of change, including growth-curve analyses, survival analyses, and mechanisms of change, to better identify gender differences in the course of illness among persons with mental disorders. Treatment Effectiveness and Service Use. Both service system and clinical services research are needed to understand the impact of organizational, financing, and management factors on the way in which women use services; and how well treatments previously shown to work under controlled conditions (efficacy) perform when applied to women in real world settings (effectiveness). Studies are needed on: o the barriers to the accurate recognition, diagnosis, and effective treatment of women with mental disorders who are seen in primary care, hospital, or nursing home settings o the effect gender has on chosen pathways to care, the choice of care provider (including informal providers and support groups), and outcomes of care o age, gender, and cohort effects on pathways to care (older women rarely seeking mental health professionals) and how treatment patterns are affected by age and gender of the patient (e.g., inappropriate sedative or hypnotic prescriptions) o health care providers' treatment patterns for women and minorities in primary care settings, hospitals, community mental health centers, and nursing homes o the acceptability and effectiveness of clinically efficacious treatments for women o differences in the relationship between the process of providing mental health services (e.g., therapeutic alliance) and patient outcomes across gender as well as other factors, such as personality type, culture, and type and severity of disorder. 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 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, 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. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard application deadlines as 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 of the face page of the application. Applicants should also specify under which support mechanism they are applying under. FIRST (R29) applications 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. Applicants from institutions that have an NIMH Center, or a General Clinical Research Center (GCRC) funded by the NIH National Center for Research Resources, may wish to identify the center as a resource for conducting the proposed research. If so, a letter of agreement from either the center program director or principal investigator could be included with the application. 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 courier/overnight mail 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. Review Criteria The following review criteria apply to research project grants (R01 and R29). Criteria for other mechanisms vary. Applicants should consult specific mechanism announcements and with program staff (listed under INQUIRIES) for further information. o scientific, technical, or medical 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 the resources necessary to perform the research o appropriateness of the proposed budget and duration in relation to the proposed research 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 the 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 peer review, availability of funds, and program priority. As part of the NIMH Public-Academic Liaison (PAL) initiative, special encouragement is given to applications that involve active collaborations between academic researchers and public sector agencies in planning, undertaking, analyzing, and publishing research pertaining to persons with severe mental disorders. The PAL initiative is based on the premise that important new advances in understanding and treatment of severe mental disorders can result from improved linkages between the Nation's scientific resources and the public sector agencies and programs in which many persons with severe mental disorders receive their care. The scope of the PAL initiative encompasses public sector agencies of all types that deal with children, adolescents, adults, and elderly persons with severe mental disorders. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Delores Parron, Ph.D. Associate Director for Special Populations National Institute of Mental Health 5600 Fishers Lane, Room 17C-14 Rockville, MD 20857 Telephone: (301) 443-2847 FAX: (301) 443-8552 Email: delores_parron@nih.gov Direct inquiries regarding fiscal matters to: Diana S. Trunnell Grants Management Branch National Institute of Mental Health 5600 Fishers Lane, Room 7C-08 Rockville, MD 20857 Telephone: (301) 443-3065 Email: delores_parron@nih.gov The National Institute on Drug Abuse (NIDA) is not participating in this program announcement, but continues to fund research in the area of women's health and drug abuse through regular grant application process. For more information call or write to: Cora Lee Wetherington, Ph.D., Division of Basic Research National Institute on Drug Abuse 5600 Fishers Lane, Room 10A-20 Rockville, MD 20857 Telephone: (301) 443-1263 FAX: (301) 594-6043 Email: cw84g@nih.gov The National Institute of Nursing Research (NINR) is not participating in this program announcement, but continues to fund research in the area of women's health as it relates to nursing practice through the regular grant application process. For more information call or write to: J. Taylor Harden, Ph.D. R.N. Health Promotion/Disease Prevention Branch National Institute of Nursing Research Building 45, Room 3AN-12 Bethesda, MD 20892-6300 Telephone: (301) 594-5976 FAX: (301) 480-8260 Email: tharden@ep.ninr.nih.gov Although not cosponsoring this program announcement, the National Institute on Aging (NIA) sponsors a broad range of research activities on biological, clinical, social and behavioral issues in women's health as they age. Many of these topics are relevant to women's mental health. Inquiries about NIA's sponsorship of these activities may be directed to: Dr. Robin A. Barr Office of Extramural Affairs National Institute on Aging Gateway Building, Suite 2C218 7201 Wisconsin Avenue MSC 9205 Bethesda, MD 20892-9205 Telephone: (301) 496-9322 FAX: (301) 402-9245 Email: barr%nihniagw.bitnet@cu.nih.gov AUTHORITY AND REGULATION This program is described in the Catalog of Federal Domestic Assistance No. 93.242. 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 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. Awards will be administered under PHS grants policy as stated in the Public Health Service Grants Policy Statement (April 1, 1994). As part of PL 102-321 (ADAMHA Reorganization Act of 1992), the NIMH, through the Associate Director for Special Populations, shall develop, coordinate, and support programs of basic and applied biological, pharmacological, social, and behavioral research on the mental health problems of women. 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. .
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