Full Text ES-94-005 ENVIRONMENTAL EQUITY: PARTNERSHIPS FOR COMMUNICATION NIH GUIDE, Volume 23, Number 1, January 7, 1994 RFA: ES-94-005 P.T. 34 Keywords: ENVIRONMENT Information Science/Systems National Institute of Environmental Health Sciences Letter of Intent Receipt Date: March 01, 1994 Application Receipt Date: April 01, 1994 PURPOSE The purpose of this program is to strengthen the NIEHS effort that supports research aimed at achieving environmental equity for socioeconomically disadvantaged and medically underserved populations in the United States. One goal of the NIEHS is to stimulate investigative efforts that attempt to address questions related to the influence of economic and social factors on the health status of individuals exposed to environmental toxicants. This component of the NIEHS environmental equity research program is designed to stimulate community outreach, training, and education efforts that will become the catalyst for reducing exposure to environmental pollutants in underserved populations. The main objective of this RFA is to establish a new paradigm for linking members of a community who are directly affected by adverse environmental conditions with researchers and health care providers. This will ensure that: o the community is aware of basic environmental health concepts, issues, and resources; o the community has a role in identifying and defining problems and risks related to environmental exposures; o the community is included in the dialogue shaping potential future research approaches to the problem; and o the community actively participates with researchers and health care providers in developing responses and setting priorities for intervention strategies. The aim of this program is to facilitate the process of developing the trust needed for establishment of effective partnerships among individuals who are adversely impacted by an environmental hazard in a socioeconomically disadvantaged community, researchers in environmental health, and health care providers. 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, "Environmental Equity: Partnerships for Communication," is related to the priority area of Environmental Health. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001- 00474-0) or "Healthy People 2000" (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 for-profit and nonprofit organizations, both public and private including predominantly minority institutions, individually or as joint efforts of minority institutions and majority institutions. Usually, only one award under this RFA will be funded at an institution. While a single institution must be the applicant, a multi-institutional arrangement (consortium) is possible. Such consortia, entailing active participation by more than one organization, are encouraged if there is clear evidence of close interaction among the participants. It is important to note that, because of the wide range of environmental health problems to be addressed and the diversity of affected communities, applications should include at least one of each of the following: o A research scientist in environmental health sciences (such as those at NIEHS Environmental Health Sciences Centers). o A primary health care provider directly involved in a community affected by an environmental pollutant. This individual could, but need not necessarily, be affiliated with a county or state public health department. o A member of an organization representing an underserved community affected by an environmental pollutant. The NIEHS has a significant commitment to the support of programs designed to increase the number of underrepresented minority and female scientists participating in biomedical and behavioral research. Therefore, applications from minority individuals and women are encouraged. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) Education Grant (R25). Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The total project period for applications submitted in response to the present RFA may not exceed four years, and projects are not renewable. This RFA is a onetime solicitation for applications for new awards. Future unsolicited competing continuation applications will compete with all investigator-initiated applications and be reviewed according to the customary peer review procedures. FUNDS AVAILABLE The estimated total funds available for the first year of support for the entire program are anticipated to be $500,000. The maximum award will be $150,000 in direct costs per year. It is anticipated that one to three grants will be awarded depending upon the availability of funds for this purpose and the quality of the applications received. RESEARCH OBJECTIVES The Extent of the Problem Americans want to live long and healthy lives, and the majority of them achieve that goal. In general, however, people who are economically disadvantaged and/or who live or work in areas and occupations where conditions impart greater exposure to hazardous substances are less likely to do so. At every stage of life, these persons suffer disproportionate levels of morbidity and mortality. Evidence suggests that certain groups, especially minorities and low-income communities, bear an uneven share of hazardous environmental exposures. Socioeconomically disadvantaged people suffer the lowest life expectancy and highest adverse health consequences of inadequate access to high-quality health care. Additionally, they most often experience the highest degree of exposure to environmental agents and frequently have the least information available about the health consequences of exposure to these agents. Environmental equity refers to the perceived unequal burden of residential exposure to greater than acceptable levels of environmental pollution, occupational exposure to hazardous substances, and fewer civic benefits such as sewage and water treatment borne by socioeconomically disadvantaged persons. Geographic location plays an important role in environmental exposure of socioeconomically disadvantaged persons. Inner city poor often live in homes with high lead levels. They may also be exposed to higher levels of air pollution. Toxic wastes sites are more frequent in rural, low socioeconomic counties in the US. Nuclear facilities and chemical plants are often located in rural areas. Exposure to pesticides is another example where rural, socioeconomically disadvantaged populations are at a greater than average risk. Disadvantaged neighborhoods may rely on well water, which may be polluted with toxic chemicals. In addition, medical care is often inadequate or unavailable to a significant proportion of the socioeconomically disadvantaged and minority people in America today. Lead poisoning and the cognitive and developmental damage associated with exposure to lead occur disproportionately among minorities. High blood pressure and prostate cancer are very common among African-Americans. Low birth weight babies and other problems during pregnancy are common among groups of women who do not have access to good prenatal care. Some of these conditions or other diseases may have an environmental component in their etiology. The lack of resources for early identification of the effects of toxic agents may lead to an increased disease burden in people who are economically least able to cope with it. Recent progress and opportunities Some work has been done to investigate the effects of pesticides in agricultural workers, of polychlorinated biphenyls in children in rural areas, and of lead exposure in socioeconomically disadvantaged urban children. The effect of low versus high air pollutant exposure on pulmonary function has been extensively studied. Evidence from the NHANES study has shown that, for comparable levels of exposure, different racial groups have different levels of blood lead. Some evidence is also available that suggests the toxic effects of some agents such as lead can be mitigated by good nutrition. Many of these studies have used underserved populations, but none have focused on such problems from the perspective of identifying issues of highest impact on these populations. Thus, progress has been minimal in most areas due to the lack of well-developed studies targeting socioeconomically disadvantaged populations. More effort must be put into defining disadvantaged populations having high levels of exposure to various types of environmental hazards in residential or occupational settings. Comprehensive outcomes to these exposures must be defined and measured. Prevention and treatment of these effects must also be generated. Prominent among the goals of the NIEHS is support of research aimed at achieving environmental equity for all populations. It is equally important to bring minority populations into the mainstream of biomedical research as scientists, health care providers, and allied health service professionals. Both of these goals have a clear benefit to the health of the nation and provide a means of addressing a potential labor shortage in the twenty-first century. As one new aspect of this effort, the NIEHS is requesting submission of applications that focus on establishing new avenues of communication among those living or working in a community impacted by an environmentally-related health problem and the researchers and health care providers attempting to ameliorate such problems. Objectives and Scope The main objective of this program is to establish a new paradigm linking members of the community, who are directly affected by adverse environmental conditions, with researchers and health care providers. Development of community-based strategies to address environmental health problems requires approaches that are not typically familiar to the research and medical communities. Customary approaches to risk assessment and management often neglect the sociocultural context of environmental hazards. The distinctive needs of individual communities and their inhabitants are only rarely considered in identifying environmental health problems and devising appropriate medical intervention tactics. Underserved populations are often diverse, fragmented, and isolated, making it difficult to obtain their input and to integrate their concerns in decision-making processes. Assays of the health effects of environmental pollution, as well as regulations based on such assays, are often performed with little or no input from the affected community. The purpose of this program is to institute mechanisms to bridge this communication gap. Applicants are therefore expected to create partnerships between researchers in environmental health, health care providers, and representatives of low-income or minority communities affected by environmental health problems. Types of activities that may be proposed include, but are not limited to: o Develop efficacious methods for risk communication in minority and low-income communities unfavorably impacted by environmental hazards. o Develop community-based, culturally sensitive educational programs to mitigate adverse health effects from environmental toxicants in minority and low-income communities. o Carry out community-based training to increase environmental health literacy, i.e., increase awareness of the public, in such neighborhoods. o Train and educate neighborhood health care professionals in the diagnosis and treatment of disorders having an etiology related to exposure to hazardous substances, i.e., increase awareness of health care providers. These providers should have a direct role in assisting a community affected by exposure to an environmental hazard. NIEHS wishes to encourage a broad, comprehensive approach to this problem. Applicants are encouraged to consider proposing some combination of the above activities. The following factors should be included in applications submitted in response to this RFA: o A means of establishing effective input from an underserved community affected by an environmental toxicant. For example, applicants may consider creating a community-based advisory board or steering committee to facilitate outreach efforts. This input could be obtained directly from members of a community affected by an environmental toxicant as well as from representatives of such groups as community and neighborhood associations, churches, public housing resident councils, community health centers, local public health service departments, and minority educational institutions. o An objective assessment process designed to identify priority areas in environmental health as perceived by community members, to develop a consensus among community members as to plausible approaches, and to detect any potential constraints in implementing the project. o Development of a plan for the most effective means of reaching the target audience. For example, many socioeconomically disadvantaged persons tend not to obtain information from the written word. Low- or no- literacy, as well as bilingual, materials may need to be generated. o Development of appropriate education/communication modules. Proposed projects should provide for dissemination of relevant information within the community as well as a voice that reaches researchers and health care providers. There should be an effective flow of information among all participants. o Feedback and evaluation of the project's effectiveness. A procedure should be established to assess the usefulness of the project's education/communication activities. o Recommendations for future activities, beyond the period of NIEHS funding, to assure continued participation of community members in research and service programs addressing environmental inequities. It is important to note that award of a grant under this RFA by the NIEHS does not imply a commitment to future funding of any programs planned with the support of such a grant. Separate applications must be submitted for such programs and such applications will be evaluated on the basis of their own merits. SPECIAL REQUIREMENTS To encourage applicants to share information gained via these projects, directors of these grants will be asked to attend an annual meeting at NIEHS. 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 will be 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 in 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 should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS 398 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 includes human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, 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. If the required information is not contained within the application, it will be returned to the applicant. 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 will be 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 1, 1994, a letter of intent that includes a descriptive title of the proposed project, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. The letter of intent influences neither review nor funding decisions, but it is helpful to NIEHS staff in planning the review process, e.g., in estimating workload and avoiding conflict of interest. Letters of intent should be directed to: Ethel B. Jackson, D.D.S. Division of Extramural Research and Training National Institute of Environmental Health Sciences P.O. Box 12233, MD 17-09 Research Triangle Park, NC 27709 APPLICATION PROCEDURES Applicants are to use Standard Form PHS 398 (rev. 9/91), which is available from most institutional offices of sponsored research and the Office of Grants Information, Division of Research Grants, National Institutes of Health Westwood Building, Room 449, Bethesda, MD 20892, telephone 301/496-7441. The RFA label available in the PHS 398 (rev. 9/91) 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. In order to assure proper identification of the application, item 2a of the application form should be filled in as follows: Check the box indicated as "yes," enter the RFA number as ES-94-05 and the title as "Environmental Equity: Partnerships for Communication." Each application should be presented in the format used for an NIH research grant. Mail the complete original application and three copies to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892 (Courier Services Zip Code 20816) To expedite review, two copies should also be sent to: Ethel Jackson, D.D.S. Division of Extramural Research & Training National Institute of Environmental Health Sciences P.O. Box 12233 Research Triangle Park, NC 27709 All human and animal welfare as well as misconduct assurances must be complete for a application to be reviewed. All follow-up assurances and approvals submitted as pending must be received within 60 days of the application receipt deadline as the application will not be reviewed. The following is the schedule planned for this initiative. It should be noted that this schedule may be changed without notification due to factors that were unanticipated at the time of the announcement. Please contact the program official listed below regarding any changes in the schedule. Receipt of Letters of Intent March 1, 1994 Application Receipt Deadline April 1, 1994 Initial Scientific Review June/July 1994 Advisory Council Review September 1994 Funding September 30, 1994 REVIEW CONSIDERATIONS Review will be carried out by the Scientific Review Branch, Division of Extramural Research and Training. Applications will be screened by staff for responsiveness to the RFA. Those considered unresponsive will be returned to the applicant without review. Responsive applications will be reviewed by either the Environmental Health Sciences Review Committee or a special review committee impaneled by the Scientific Review Branch. If a greater number of applications are received than anticipated, NIEHS will triage the applications. Those applications identified as the most competitive will be given a full scientific review and a complete and detailed summary statement will be prepared. The other applications will be administratively withdrawn from competition and the applicant and institutional official so notified. The second level of review will be provided by the National Advisory Environmental Health Sciences Council. The major review factors listed below will be used in evaluation of applications for this RFA: o Scientific, technical, and/or medical significance and merit of the proposed project as determined by such factors as its content, originality, and feasibility. o Evidence of access to interaction with, input from a minority or low-income, or underserved community, whose members' health is adversely impacted by an environmental toxicant. There should also be evidence of effective involvement of such a community in development of the application. o Capacity of the project to: Identify key environmental hazards that affect the health and quality of life of people who live in or around communities thought to be at risk. Establish a focus for information exchange related to environmental health problems in socioeconomically disadvantaged communities. Enhance awareness of environmental health problems among members of the public and/or health care providers living or working in minority or low-income communities. Have a direct impact on the health or quality of life of individuals in affected communities, e.g., by diminishing exposure to environmental toxicants. o Appropriateness and adequacy of the approach and methodology proposed to accomplish the project's objectives. o Qualifications and experience of the principal investigator and staff, particularly but not exclusively in areas relevant to the mission of NIEHS. Personnel should demonstrate knowledge of the needs of their target audience. Applications must include, at a minimum, a researcher in environmental health sciences, a health care provider, and a member of an organization representing an underserved community affected by an environmental pollutant. There should be evidence of effective cooperation and interaction among these staff members in development of the application as well as in execution of the project. o Structure and function of the community-based advisory board or steering committee. This group should facilitate information exchange and achievement of the project's objectives. There should also be evidence of effective involvement of the advisory board in development of the application. o Strength of institutional commitment as evidenced by provision of appropriate resources, services, technical support, and allocation of space. o Availability of resources necessary to carry out the project. o Appropriateness of the proposed budget and duration in relation to the project's objectives. o Plans for evaluation of factors contributing to the project's effectiveness. Evaluations should include a measure of the impact of the project on community members' knowledge and awareness of issues and resources related to environmental health sciences. AWARD CRITERIA The following will be considered in making funding decisions: o Quality of the proposed applications as determined by peer review. o Responsiveness to the goals of this RFA and the mission of the NIEHS. o Availability of funds. Although this program is provided for in the financial plans of the NIEHS, awards pursuant to this RFA are contingent upon the availability of funds for this purpose. Funding beyond the first and subsequent years of the award will be contingent upon satisfactory progress during the preceding year and upon availability of funds. INQUIRIES NIEHS staff welcome the opportunity to clarify any issues or questions from potential applicants. Written or telephone inquiries concerning the objectives, scope, and application procedures for this RFA or inquiries about whether specific proposals would be responsive are encouraged and should be directed to: Donald McRee, Ph.D. Environmental Health Resources Branch National Institute of Environmental Health Sciences P.O. Box 12233 Research Triangle Park, NC 27709 Telephone: (919) 541-7634 Questions of an administrative or fiscal nature not directly related to the programmatic aspects of this RFA should be directed to the Grants Management Branch official listed below: Mr. David Mineo Grants Management Branch National Institute of Environmental Health Sciences P.O. Box 12233 Research Triangle Park, NC 27709 Telephone: (919) 541-7628 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Number 93.113, 93.114 and 93.115. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 100-607) and administered under PHS grant policies and Federal Regulations 42 CFR Part 52 and 45 CFR Part 74. The program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. .
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