CULTURAL COMPETENCE AND HEALTH DISPARITIES ACADEMIC AWARD RELEASE DATE: December 12, 2003 RFA Number: RFA-HL-04-012 Department of Health and Human Services (DHHS) PARTICIPATING ORGANIZATION: National Institutes of Health (NIH) (http://www.nih.gov) COMPONENT OF PARTICIPATING ORGANIZATION: National Heart, Lung, and Blood Institute (NHLBI) (http://www.nhlbi.nih.gov) CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER(S): 93.837, 93.838, 93.839 LETTER OF INTENT RECEIPT DATE: January 23, 2004; September 19, 2004; September 19, 2005. APPLICATION RECEIPT DATE: February 23, 2004; October 19, 2004; October 19, 2005. THIS RFA CONTAINS THE FOLLOWING INFORMATION o Purpose of this RFA o Research Objectives o Mechanism(s) of Support o Funds Available o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Special Requirements o Where to Send Inquiries o Letter of Intent o Submitting an Application o Supplementary Instructions o Peer Review Process o Review Criteria o Receipt and Review Schedule o Award Criteria o Required Federal Citations PURPOSE OF THIS RFA The overall objective of this program is to enhance the ability of physicians and other health care professionals, to address disparities in the occurrence, management, and outcomes of cardiovascular, pulmonary, hematological, and sleep disorders among various population groups in the U.S. in a culturally sensitive manner. This academic award provides support to medical institutions in the U.S. to develop core curricula and other educational materials that will increase the overall knowledge and skills of medical students, house staff, and other professionals, including practicing physicians on the ethnic, cultural, religious, socioeconomic, linguistic and other factors that contribute to health disparities, and on culturally competent approaches to mitigating these disparities. RESEARCH OBJECTIVES Racial, ethnic, cultural and linguistic differences that exist in the U.S. population present a unique challenge for the practice of medicine. Despite major improvements in the overall national health in the U.S., major disparities continue to exist in the health status, incidence of illness, and access to health care among different population groups. This is particularly true for minority populations, such as African Americans, Latino/Hispanic Americans, Native Americans, Alaska Natives and Pacific Islanders, who face a disproportionate burden of disease compared to the non-minority U.S. population. Hypertension, cardiovascular diseases, stroke, sickle cell disease, sleep disorders and asthma are several diseases within the mission of the NHLBI that disproportionately affect minorities. Among the factors that are believed to be associated with health disparities are national origin, ethnicity, cultural, linguistic and family backgrounds, individual experiences, age and gender, financial status, geographic location, educational level, and occupation. Physician’s lack of knowledge and experience with these factors may further exacerbate their effects. Lack of diversity in the workforce may also contribute to health care industry’s inability to meet the needs of diverse patient populations, thereby affecting the quality of care and contributing to health disparities. For the purpose of this RFA, cultural competence is defined as the health care provider’s ability to deliver culturally appropriate and specifically tailored care to patients with diverse values, beliefs, and behaviors. Very few programs are currently available to train health care providers on the health implications of cultural diversity and how they shape a person’s approach to health and illness. Especially lacking are didactic courses and training programs that enhance physician knowledge of the manifold factors that influence the health needs and attitudes of people from diverse backgrounds, and of ways to apply this knowledge in patient care. This Cultural Competence and Health Disparities Academic Award initiative seeks to fill this gap by promoting the development and use of relevant curricula in medical schools, as well as the training of physicians already in the health care pipeline. This program is designed to provide resources to domestic medical institutions, to develop mechanisms that offer students and physicians, knowledge, sensitivity and experience in understanding and managing cultural barriers to health care, and to enable institutions to develop best practices in the delivery of optimal health care to multiethnic populations with heart, lung, blood or sleep disorders. It is hoped that this program will impact public health by identifying factors that increase risk to specific diseases and help physicians deliver the best possible health care. The Program This program will be implemented in two phases: Curriculum Development, and Implementation. 1) Curriculum Development Phase: This phase will include: (i) the identification of elements or components of core curricula for medical schools on cultural sensitivity and health disparities, and (ii) the development, testing and utilization of relevant materials and resources in appropriate settings. The course(s), materials and resources will especially: a) focus on the factors (e.g., cultural, religious and geographic backgrounds; beliefs; values; traditions; attitudes; and practices) that affect health, and disease occurrence; b) examine how these factors may influence medical help seeking behavior, compliance, adherence, and response to treatment; and c) identify strategies for delivering culturally sensitive information and interventions to the health care professionals. It is desirable that in addition to medical students, house staff, and other professionals, including practicing physicians are incorporated into the program. Each applicant will describe: a) plans for the development of curricula and other materials, including procedures to evaluate the process and progress of curriculum development, plans for enlisting the support of professional and other organizations involved in medical education in these efforts; and b) plans and milestones for institutionalizing the curricular changes. These efforts may eventually culminate in the development of a single curriculum, or, if deemed necessary and justified, more than one curriculum. The curricula and any educational materials designed must be suitable for implementation at other sites. The curricula may be developed in the context of a single or several- multiple ethnic/cultural group(s) and disease category(ies), or some combinations of these to provide one broadly applicable. The curricula may be adaptable into existing courses, or as stand-alone customized course(s). It is expected that this phase will be completed in 24 30 months. 2) Implementation and Training Phase: The curriculum development should be followed by an implementation phase that includes evaluation of products in appropriate settings (e.g., classrooms, professional meetings, focus groups, etc) and dissemination of educational materials, to the medical education community. This will include medical schools, and organizations coordinating residency programs, post-graduate courses, and continuing medical education, etc. It is expected that appropriate outlets will be used to encourage their integration into medical school curricula as well as training programs for physicians in practice, to help enhance their cultural competence and ability to deal with health disparities in the U.S. Each applicant should detail plans for conducting and testing the effectiveness of the proposed curriculum, including benchmarks against which success of the program can be measured. In addition, to aid in the selection of the coordinating center each applicant must indicate how the investigators will coordinate their efforts with those of other participants in this program, expected to number 10-12. The coordination efforts should include, among others, organization of group meetings and conference calls to develop common ideas and plans for completing the two phases of the program as detailed above, and for generating interim and final progress reports. The NHLBI will designate one of the awardees as the Coordinating Center and will provide additional funds earmarked for carrying out the coordinating responsibilities. The NHLBI will work closely with the Coordinating Center as well as the individual awardees, as necessary, to help meet the goals of the program, namely, the development and dissemination of curricula and other educational resources designed to enhance the cultural competence of health-care providers and reduce health disparities in the nation. MECHANISM OF SUPPORT This RFA will use the NIH K07 Academic Career Award mechanism. As an applicant, you will solely be responsible for planning, directing, and executing the proposed project. See the SUPPLEMENTARY INSTRUCTIONS section for additional information. An unsuccessful application to this RFA for one receipt date may be submitted as an amended application at a later receipt date. The anticipated award date for the first receipt date is September 30, 2004; for the second is July 1, 2005; and for the third is July 1, 2006. FUNDS AVAILABLE The NHLBI intends to commit approximately $24 million over a seven-year period in response to this RFA. Ten to 12 applications will be funded per announcement (a total of 30 to 36 applications in response to three announcements). An applicant must request a project period of 5 years and a budget for direct costs (DC) up to $120,000 per year. Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size of each award will also vary. Although the financial plans of the NHLBI provide support for this program, awards pursuant to this RFA are contingent upon the availability of funds and the receipt of a sufficient number of meritorious applications. ELIGIBLE INSTITUTIONS You may submit an application if your institution has any of the following characteristics: o For-profit or non-profit organizations o Public or private institutions, such as a universities, colleges, hospitals, and laboratories o Units of State and local governments o Domestic institutions/organizations o Foreign institutions are not eligible to apply An eligible institution (e.g., university) may submit only a single application in response to this RFA. Multiple applications from different divisions, faculties, centers, schools, etc. at the same university will be returned without further consideration by the NIH. INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Individuals with the skills, knowledge, and resources necessary to carry out the proposed academic program are invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are especially encouraged to apply. The candidate must be an established, independent and qualified professional of a health care institution or medical faculty in an accredited school of medicine or osteopathy in the U.S., its territories, or its possessions; must be in a position to devote at least 30 but not more than 50 percent effort to the program for a five- year period; a faculty member interested in medical education programs related to the mission of the NHLBI; have the potential to develop and implement a high quality educational curriculum; have the support of the educational leadership at the institution and demonstrate knowledge and commitment in cultural aspects of medical education for medical students, physicians, physicians in training, patients, nurses, and the public. SPECIAL REQUIREMENTS The educational materials for curricular improvements resulting from this program must be amenable to adaptation at other sites. All applications must also include plans to evaluate the outcomes of this educational and research initiatives. The responsibilities of the Principal Investigator and key personnel must be clearly stated at the beginning of the research plan and placed in the context of other institutional and research commitments. Since the Cultural Competence and Health Disparities Academic Award primarily provides support for the salary of the Principal Investigator, applications that are contingent on receiving support from other agencies and institutions must identify these resources in relationship to the proposed program plan. Allowable Cost: The salary for the Principal Investigator must be in conformance with the institutional salary rates for the effort devoted to the Academic Award, subject to the maximum legislated salary rate in effect at the time of award. The institution may supplement the NIH salary up to a level consistent with the institution's salary scale. However, institutional supplementation of salary must not require extra duties or responsibilities that would interfere with the purpose of the Academic Award. Support & Development: Funds may be requested for technical support up to a maximum of $25,000 DC per year for the following: a) personnel other than the PI, if required, (e.g., technical and support staff and consultants, educational and evaluation specialists) for development, implementation, and evaluation of the program; b) consumable supplies essential to the proposed program are allowable, but equipment costs are not allowable; c) funds for travel for the Principal Investigator to meet in Bethesda, Maryland with other investigators and NHLBI staff to exchange ideas, develop collaborative projects, and provide needed technical support ($2,000 should be allocated for this purpose for two trips per year). The institution selected as coordinating center will receive an additional $25,000 DC for personnel support and $20,000 DC for administrative expenses to cover conference calls, arranging meetings, organization of committees, preparation of program status reports, overall evaluation of the program, and plans for dissemination of educational materials generated by this program. In the final year of the program $40,000 will be provided to the coordinating center for organizing a conference for wide dissemination of the group’s curricular development and training. These funds should not be requested in the budget. Awards will be provided for the reimbursement of facilities and administrative (F&A) costs at a rate of eight percent of total direct costs. WHERE TO SEND INQUIRIES We encourage inquiries concerning this RFA and welcome the opportunity to answer questions from potential applicants. Inquiries may fall into three areas: scientific/research, peer review, and financial or grants management issues. o Direct your questions about scientific/research issues to: H ctor Ortega, M.D., Sc.D. Division of Lung Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 1008, MSC795 Bethesda, MD 20892 Telephone:(301) 435-0202 FAX:(301) 480-3557 Email:ortegah@mail.nih.gov Susan Czajkowski, Ph.D. Division of Epidemiology and Clinical Applications National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room Bethesda, MD 20892 Telephone: (301) 435-0406 FAX:(301) 480-1773 Email: czajkows@mail.nih.gov Beth Schucker, M.S. Division of Heart and Vascular Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room Bethesda, MD 20892 Telephone: (301) 435-0535 FAX:(301) 480-1335 Email: schuckeb@mail.nih.gov Ellen Werner, Ph.D. Division of Blood Diseases and Resources National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room Bethesda, MD 20892 Telephone: (301) 435-0061 FAX:(301): (301) 480-0867 Email: wernerem@mail.noh.gov o Direct your questions about peer review issues to: Anne P. Clark, Ph.D. Chief Review Branch Division of Extramural Affairs National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7178, MSC 7924 Bethesda, MD 20892-7924 Bethesda, MD 20817 (for express/courier service) Telephone: (301) 435-0270 FAX: (301) 480-0730 Email:clarka@nhlbi.nih.gov o Direct your questions about financial or grants management matters to: Mr. Howard Moore Division of Extramural Affairs National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7156 Bethesda, MD 20892 Telephone: (301) 435-0171 Email:piker@nhlbi.nih.gov LETTER OF INTENT Prospective applicants are asked to submit a letter of intent that includes the following information: o Descriptive title of the proposed application o Name, address, and telephone number of the Principal Investigator o Names of other key personnel o Participating institutions o Number and title of this RFA Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NHLBI staff to estimate the potential review workload and plan the review. The letter of intent is to be sent by the date listed at the beginning of this document to Dr. Anne Clark at the address listed under the WHERE TO SEND INQUIRES. SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). Applications must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number as the Universal Identifier when applying for Federal grants or cooperative agreements. The DUNS number can be obtained by calling (866) 705-5711 or through the web site at http://www.dunandbradstreet.com/. The DUNS number should be entered on line 11 of the face page of the PHS 398 form. The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 710-0267, Email: GrantsInfo@nih.gov. SUPLEMENTARY INSTRUCTIONS Applicants should follow these modified instructions from the PHS 398 Section IV (Research Career Award) in preparing an application. In the Section for Budget (Table of Contents (TC) Section I,4) the applicant should include a categorical budget as described in the special requirements section of this RFA. Applicants do not need to provide sponsor/mentor related information (e.g. letters of support, other support for the Mentor) (TC Section I,6) or Career Goals and Objectives & Development Activities information (TC Section II,3.B & 3.C). Additionally, because development and implementation of educational materials do not require specific hypothesis to be tested, a hypothesis is not required (TC Section II, 6.A). However, in the section for Research Plan a clear description of specific aims and objectives is required following the Curriculum development and Implementation sections described in this RFA. Coordinating Center: At the end of the Research Plan, each application must provide a coordinating plan as described under RESEARCH OBJECTIVES, The Program. Applicants are allowed up to three additional pages for the description of their coordinating plan. USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) application form must be affixed to the bottom of the face page of the application. Type the RFA number on the label. 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 2 of the face page of the application form and the YES box must be marked. The RFA label is also available at: http://grants.nih.gov/grants/funding/phs398/labels.pdf. SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the Checklist, and three signed, photocopies, in one package to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 Bethesda, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application and all copies of the appendix material must be sent to Dr. Anne Clark at the address listed under WHERE TO SEND INQUIRES. APPLICATION PROCESSING: Applications must be received on or before the application receipt date listed in the heading of this RFA. If an application is received after that date, it will be returned to the applicant without review. Although there is no immediate acknowledgement of the receipt of an application, applicants are generally notified of the review and funding assignment within 8 weeks. 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. However, when a previously unfunded application, originally submitted as an investigator-initiated application, is to be submitted in response to an RFA, it is to be prepared as a NEW application. That is, the application for the RFA must not include an Introduction describing the changes and improvements made, and the text must not be marked to indicate the changes from the previous unfunded version of the application. PEER REVIEW PROCESS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by the NHLBI. Incomplete and/or nonresponsive applications will not be reviewed. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NHLBI in accordance with the review criteria stated below. As part of the initial merit review, all applications will: o Undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of the applications under review, will be discussed and assigned a priority score o Receive a written critique o Receive a second level review by the NHLBI National Advisory Council. REVIEW CRITERIA The following review criteria will be applied: Candidate o Evidence of excellence in research and academic activities; o Experience in teaching, curriculum development, leadership, administrative skills, and/or planning and conduct of research; o Ability and commitment to work cooperatively with other awardees to develop innovative cultural competence curricula, materials, and programs available; Research Plan o Quality and feasibility of the curricular development plan including identification of strategies for delivering culturally sensitive information and interventions; o Potential of the program for making an impact on culturally competent approaches to mitigating disparities; o Quality of the evaluation plan of the proposed training and educational program(s); o Plans for institutionalizing the curricular program; and Environment o Commitment of the institution to strengthening research and education activities in a cultural sensitive manner in heart, lung, blood, and sleep disorders; o Commitment of the institution to the proposed level of effort related to this award; o Merit of the institution plan to strengthen educational and training activities beyond the current status of activities and capacities; o Scope and nature of collaboration among participating schools and departments; and o Adequacy of the research facilities and training opportunities for this award. Plans for Coordination o Adequacy of the proposed activities appropriate for facilitating coordination, and prior experience in performing coordination functions. Reviewers will comment on the proposed coordination plans but this will not influence the final score. PROTECTION OF HUMAN SUBJECTS FROM RESEARCH RISK: The involvement of human subjects and protections from research risk relating to their participation in the proposed research will be assessed. (See criteria included in the section on Federal Citations, below). INCLUSION OF WOMEN, MINORITIES AND CHILDREN IN RESEARCH: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria in the sections on Federal Citations, below). BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. RECEIPT AND REVIEW SCHEDULE Letter of Intent Receipt Date: January 23, 2004; September 19, 2004; September 19, 2005. Application Receipt Date: February 23, 2004; October 19, 2004; October 19, 2005. Peer Review Date: June, 2004; February 2005; February 2006. Council Review: September, 2004; June 2005; June 2006. Earliest Anticipated Start Date: September 30, 2004; July 1, 2005; July 1, 2006. AWARD CRITERIA Award criteria that will be used to make award decisions include: o Scientific merit (as determined by peer review) o Availability of funds o Programmatic priorities. REQUIRED FEDERAL CITATIONS HUMAN SUBJECTS PROTECTION: Federal regulations (45CFR46) require that applications and proposals involving human subjects must be evaluated with reference to the risks to the subjects, the adequacy of protection against these risks, the potential benefits of the research to the subjects and others, and the importance of the knowledge gained or to be gained. http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of the NIH that women and members of minority groups and their sub- populations must be included in all NIH-supported clinical research projects unless a clear and compelling justification is provided indicating 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 Public Law 103-43). All investigators proposing clinical research should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research - Amended, October, 2001," published in the NIH Guide for Grants and Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm. The amended policy incorporates: the use of an NIH definition of clinical research; updated racial and ethnic categories in compliance with the new OMB standards; clarification of language governing NIH-defined Phase III clinical trials consistent with the new PHS Form 398; and updated roles and responsibilities of NIH staff and the extramural community. The policy continues to require for all NIH- defined Phase III clinical trials that: a) all applications or proposals and/or protocols must provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) investigators must report annual accrual and progress in conducting analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: The NIH maintains a policy that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at http://grants.nih.gov/grants/funding/children/children.htm REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. Applicants may wish to place data collected under this RFA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION: The Department of Health and Human Services (DHHS) issued final modification to the Standards for Privacy of Individually Identifiable Health Information , the Privacy Rule, on August 14, 2002. The Privacy Rule is a federal regulation under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that governs the protection of individually identifiable health information, and is administered and enforced by the DHHS Office for Civil Rights (OCR). Those who must comply with the Privacy Rule (classified under the Rule as covered entities ) must do so by April 14, 2003 (with the exception of small health plans which have an extra year to comply). Decisions about applicability and implementation of the Privacy Rule reside with the researcher and his/her institution. The OCR website (http://www.hhs.gov/ocr/) provides information on the Privacy Rule, including a complete Regulation Text and a set of decision tools on Am I a covered entity? Information on the impact of the HIPAA Privacy Rule on NIH processes involving the review, funding, and progress monitoring of grants, cooperative agreements, and research contracts can be found at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-03-025.html. URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This RFA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.healthypeople.gov/. AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance at http://www.cfda.gov/ and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under the authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. All awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement. The NIH Grants Policy Statement can be found at http://grants.nih.gov/grants/policy/policy.htm The PHS strongly encourages all grant recipients to provide a smoke- free workplace and discourage the 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 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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