# Presentation: 495393

## Jean L. Flagg-Newton, PhD
Program Director
Office of Capacity Building and Infrastructure

*Program Director*
*Office of Capacity Building and Infrastructure*

**The Fiscal Year 2002 Competition**

## Purpose

- Inform participants of the authorization for the Project EXPORT Centers of Excellence
- Share our vision for the Project EXPORT Centers of Excellence
- Review the grant mechanisms available for the Fiscal Year 2002 Competition
- Resource-Related Research Project Awards (R24)
- Exploratory Center Grants (P20)
- Comprehensive Center Awards (P60)

## Minority Health and Health Disparities Research and Education Act of 2000 - Public Law 106-525

- Establishes the National Center on Minority Health and Health Disparities (NCMHD) to conduct and support research, training, dissemination of information, and other programs to support the reduction and elimination of health disparities among ethnic minority populations
- Authorizes the NCMHD Director to award grants or contracts to designated biomedical and behavioral research institutions to support programs of excellence in biomedical and behavioral research training for individuals who are members of minority health disparity populations or other health disparity populations

## Definitions - Public Law 106-525

- Health Disparities Research – Basic, clinical, and behavioral research on minority health conditions, including research to prevent, diagnose, and treat such conditions
- Minority Health Conditions – For individuals who are members of racial and ethnic minority groups, all diseases, disorders, and conditions
- Unique to, more serious, or more prevalent in
- For which factors of medical risk or types of intervention may be different
- With respect to which there has been insufficient research involving such individuals as subjects

## Definitions - Public Law 106-525 (cont'd)

- Health Disparity Populations – Any group exhibiting significant disparities in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population
- Racial and Ethnic Minority Group – Members of the four major minority groups: Asian/Pacific Islander, Blacks, Hispanics, Native Americans/Alaska Natives or a subgroup of any of these groups (Section 1707 of the Public Health Service Act)

## Congressional findings include the following:
A national need exists for minority scientists in biomedical, clinical, behavioral, and health services research; 90% of minority physicians educated at Historically Black Medical Colleges live and serve in minority communities
Demographic trends inspire concern about the Nation’s ability to meet its future scientific, technological, and engineering workforce needs; historically, non-Hispanic white males have made up the majority of the U.S. scientific, technological, and engineering workers
The Hispanic and Black populations will increase, significantly, in the next 50 years; the scientific, technological, and engineering workforce may decrease if participation by underrepresented minorities remains the same

- A national need exists for minority scientists in biomedical, clinical, behavioral, and health services research; 90% of minority physicians educated at Historically Black Medical Colleges live and serve in minority communities
- Demographic trends inspire concern about the Nation’s ability to meet its future scientific, technological, and engineering workforce needs; historically, non-Hispanic white males have made up the majority of the U.S. scientific, technological, and engineering workers
- The Hispanic and Black populations will increase, significantly, in the next 50 years; the scientific, technological, and engineering workforce may decrease if participation by underrepresented minorities remains the same

**Findings - Public Law 106-525**

## Findings (cont'd)

- Increasing rates of Black and Hispanic workers can help ensure a strong scientific, technological, and engineering workforce
- Individuals such as underrepresented minorities and women in the scientific, technological, and engineering workforce enable society to address its diverse needs
- To effectively promote a diverse and strong 21st century scientific, technological, and engineering workforce, Federal agencies should expand or add programs that effectively overcome barriers such as educational transition from one level to the next and student requirements for financial resources
- Federal agencies should work in concert with the private nonprofit sector to emphasize the recruitment and retention of qualified individuals from ethnic and gender groups that are currently underrepresented in the scientific, technological, and engineering workforce

## Findings (cont'd)

- Behavioral and social sciences research has increased awareness and understanding of factors associated with health care utilization and access, patient attitudes toward health services, and risk and protective behaviors that affect health and illness; these factors have the potential to be modified to help close the health disparities gap among ethnic minority populations; in addition, there is a shortage of minority behavioral science researchers and behavioral health care professionals; according to the National Science Foundation, only 15.5% of behavioral research-oriented psychology doctorate degrees were awarded to minority students in 1997; only 17.9% of practice-oriented psychology doctorate degrees were awarded to ethnic minorities

## THE NEED: The Community Speaks

- Significant recommendations came out of the April 2000 national conference,
- “Challenging Minority Health Disparities in the New Millennium”
- Attendees called for a network of centers with ties to racial and ethnic minority communities
- Develop a program designed to increase the number of grants from minority investigators accepted for review by NIH study sections
- Establish partnerships with Historically Black Colleges and Universities (HBCUs) and other educational institutions serving minority populations (e.g., Tribal Colleges, Hispanic-serving Institutions)
- Provide K-12 teachers with continuing educational opportunities

## THE NEED: The Community Speaks (cont'd)

- Take the lead in identifying and clarifying risk factors for different diseases and their impact on different segments of the minority population
- Develop and refine research tools, survey instruments, and databases that are culturally sensitive, competent, and specifically designed for minority populations
- Improve the infrastructures for collecting and analyzing epidemiological and demographic data on minorities
- Develop outreach programs that encourage more minorities to participate in clinical trials

## THE NEED: The Community Speaks (cont'd)

- Increase minority community involvement, at all levels, in addressing the problem of health disparities for minorities
- Take the lead in developing culturally sensitive and competent approaches to communicating with the minority community
- Support community-based research projects that focus upon recognized ethnic populations
- Identify and develop partnerships with community leaders (including representatives from the local faith community)
- Communicate research findings to participants and their families in a culturally sensitive and competent fashion

## THE NEED: DHHS Initiative

- DHHS initiative to reduce disparities in health outcomes
- AIDS
- Sponsor more studies of protective factors as well as  risk factors
- Encourage minority communities to focus more attention on prevention and decision making as it relates to high-risk behaviors
- Diabetes
- Study the effects of cultural practices and other non-clinical risk factors on development of diabetes
- Study diabetes as a complex disorder with multiple co-morbidities in minority communities

## THE NEED: DHHS Initiative (cont'd)

- Diabetes (cont’d)
- Determine the underlying physiological, metabolic, genetic, psychosocial, and behavioral factors that cause the racial and ethnic differences in the incidence of diabetes
- Develop and test appropriate and efficacious strategies for treatment and management of diabetes and its complications that are tailored to the needs of minority populations
- Cardiovascular Diseases
- Using the Jackson Heart Study as a model, identify risk factors and develop culturally sensitive strategies to prevent and treat minority populations
- Use the Center for Complementary and Alternative Medicine to investigate alternative or complementary health care strategies

## THE NEED: DHHS Initiative (cont'd)

- Cancer
- Improve methods for collection and dissemination of data and promote surveillance studies with the development of data banks, databases, “registries” of information on minority populations (include the collection of data on cancer detection, treatments, and outcomes
- Compare risk factors for majority and minority populations
- Study health-promoting behaviors of minority populations
- Children’s Health/Infant Mortality
- Identify successful models from foreign countries
- Promote holistic approaches in addressing reproductive health issues

## Project EXPORT Centers of Excellence Concept 

- Grass Roots Strategy
- Intent is to match the needs of the community with the strengths of local institutions
- Emphasis is on establishing Project EXPORT Centers within geographic areas with specific demographic characteristics
- Must also ensure that geographical regions with the greatest disparities in health status are given priority

## Percent Desperately Poor (US Census 1989)

**Percent Desperately Poor ****(US Census 1989)**

## Quest for Linking Centers to Affected Communities

- Nearly 20,000,000 white individuals live below the poverty line with many living in non-metropolitan, rural areas such as Appalachia
- A high percentage of counties designated as health professional shortage areas (47 percent) and the high rate of poverty contribute to disparity outcomes
- However, there is a higher proportion of racial and ethnic minorities in the United States represented among the medically underserved
- See handout on the Metropolitan Statistical Areas

## Percent of Population Poor (US Census 1989)

**Percent of Population Poor ****(US Census 1989)**

## Percent of African Americans (US Census 1990)

## Percent of HispanicAmericans (US Census 1990)

## Percent of AsianAmericans (US Census 1990)

## Percent of NativeAmericans (US Census 1990)

## Demographics in DHHS Regions by Racial and Ethnic Group

- Legend

**Region I**:  NH, ME, VT, RI, MA, CT	**Region II**:  NJ, NY, PR, VI
**Region III**:  VA, DE, MD, PA, WV, DC	**Region IV**:  AL, FL, GA, KY, MS, SC, NC, TN
**Region V**:  IL, IN, MI, OH, WI	**Region VI**: AR, LA, NM, OK, TX
**Region VII**:  MO, KS, NE, IA, MN	**Region VIII**:  CO, MT, ND, SD, UT, WY
**Region IX**:  AZ, CA, HI, NV, Pacific	**Region X:**  AK, ID, OR, WA
-    Basin, Guam

**Demographics in DHHS Regions ****by Racial and Ethnic Group**

## Demographics in DHHS Regions by Racial and Ethnic Group (cont'd)

- Population scale differs by at least 10

- Population scale differs by at least 10

**Region I**:  NH, ME, VT, RI, MA, CT	**Region II**:  NJ, NY, PR, VI
**Region III**:  VA, DE, MD, PA, WV, DC	**Region IV**:  AL, FL, GA, KY, MS, SC, NC, TN
**Region V**:  IL, IN, MI, OH, WI	**Region VI**: AR, LA, NM, OK, TX
**Region VII**:  MO, KS, NE, IA, MN	**Region VIII**:  CO, MT, ND, SD, UT, WY
**Region IX**:  AZ, CA, HI, NV, Pacific	**Region X:**  AK, ID, OR, WA
-    Basin, Guam

**Demographics in DHHS Regions ****by Racial and Ethnic Group ****(cont'd)**

## Demographics in DHHS Regions by Racial and Ethnic Group (cont'd)

- Population scale differs by at least 10

**Region I**:  NH, ME, VT, RI, MA, CT	**Region II**:  NJ, NY, PR, VI
**Region III**:  VA, DE, MD, PA, WV, DC	**Region IV**:  AL, FL, GA, KY, MS, SC, NC, TN
**Region V**:  IL, IN, MI, OH, WI	**Region VI**: AR, LA, NM, OK, TX
**Region VII**:  MO, KS, NE, IA, MN	**Region VIII**:  CO, MT, ND, SD, UT, WY
**Region IX**:  AZ, CA, HI, NV, Pacific	**Region X:**  AK, ID, OR, WA
-    Basin, Guam

**Demographics in DHHS Regions ****by Racial and Ethnic Group ****(cont'd)**

## Project EXPORT Centers: DEMOGRAPHIC GOALS

**	****1) ****	**Applicant Institution or collaborating partner must be located within a metropolitan statistical area where the density of racial and ethnic minorities within the general population is equal to or exceeds:
- 19% for Hispanic or African Americans, respectively
- 10% for Asian Americans and Pacific Islanders
- 2% for Native Americans and Alaska Natives
-  		Additionally, the overall poverty rate within the geographic region to be served must equal or exceed the national average of 11.3%
***OR******	*****2)****	**Applicant Institution or collaborating partner must be located within a DHHS Service Region where the density of Native Americans and Alaskan Natives in the general population equals to or exceeds 200,000
***OR******	*****3)****	**Applicant Institution or collaborating partner must be located within or near a Health Professional Shortage Area or within an officially designated area of underservice

## Project EXPORT: Eligibility Criteria by Statute

- Designated biomedical and behavioral institutions have:
- A significant number of members of minority health disparity populations or other health disparity populations enrolled as students in the institution
- Been effective in assisting such students of the institution to complete the program of education or training and receive the degree involved
- Made significant efforts to recruit minority students to enroll in and graduate from the institution
- Made significant recruitment efforts to increase the number of minority or other members of health disparity populations serving in faculty or administrative positions at the institutions

## Project EXPORT: Institutional Participation

- Grant applications that include research activities involving more than one institution are considered a partnership or consortium effort, depending upon the number of institutions involved
- Collaborative partnerships may be developed between minority-serving and other “designated” institutions or between designated and non-designated institutions with substantial existing Federal research support and/or research infrastructure as reflected in the University of Florida report on research institutions (http://thecenter.ufl.edu/research_data.html)
- Partnerships and consortium arrangements are encouraged, however, it is imperative that the applications are prepared to fully explain the programmatic, fiscal and administrative considerations

## Research Goals

- The richness of America’s population diversity is overshadowed by the disproportionate burden of disease and illness borne by racial and ethnic minority populations and the rural and urban poor
- Compelling evidence of health disparities is documented in the form of
- Shorter life expectancies
- Higher rates of, cancer, birth defects, infant mortality, asthma, diabetes, cardiovascular disease
- Disproportionate burden of morbidity and mortality in other areas including (but not limited to) HIV infection/AIDS, autoimmune diseases, oral health, sexually transmitted diseases, and disease burden associated with mental disorders

## Research Goals (cont'd)

- The extent of this healthcare crisis has become known only through rigorous population and epidemiologic research
- This knowledge positions us to more completely define the scope of the problem and begin to identify and evaluate new approaches to mitigating health disparities
- Project EXPORT is central to NCMHD’s investment strategy for addressing disparities in health status
- Project EXPORT Centers will focus on research aimed at reducing and eliminating health disparities, improving research capacity, and providing outreach and education

## RFA Solicitations

- R24, P20, P60
- Demographic Goals
- Potential for broad institutional participation

## RFA Solicitations: R24

- Support research projects that will enhance the capability of resources to serve biomedical research
- Project EXPORT: Support developmental activities designed to develop or enhance the infrastructure for conducting scientifically meritorious research
- Project EXPORT: Feasibility studies, development of innovative partnership models, acquisition of data and analyses necessary to clarify/refine research questions
- Development of testable hypotheses and theories

## RFA Solicitations: P20 Exploratory EXPORT Centers

- P20: Expansion or modification of existing resources, development of interdisciplinary programs that offer potential solutions to problems of special significance
- P20: Flexible support to expand faculty research capability in complementary disciplines as well as enhance research infrastructure
- May use basic, clinical, behavioral or all research approaches to attain the goals of the proposed center

## RFA Solicitations: P60

- P60: Support a multipurpose unit designed to bring together into a common focus divergent but related facilities within a given community
- P60: Fosters biomedical research and development at both the fundamental and clinical levels, initiates and expand community education, screening and counseling programs
- P60: For designated institutions with substantial existing federal research support and/or research infrastructure as reflected in the 1998 report on research institutions (http://thecenter.ufl.edu/research_data.html)

## RFA Comparison

- Mechanisms of Support
- Available Funding
- EXPORT Center Components
- Eligibility Requirements
- Special Requirements
- Organization/Administration

- Advisory Committee
- Planning and Evaluation
- Opportunities and Restrictions
- Letter of Intent
- Application Receipt Date

## Available Funding

**Resource-Related Research Project (R24) RFA: MD-02-001**
- 10 to 12 awards
- $350,000 for up to three years
**Exploratory Grant (P20) RFA: MD-02-002**
- 5 to 6 Awards
- $1.5 million for up to five years
**Comprehensive Center Award (P60) RFA: MD-02-003**
- 5 to 6 Five-Year Awards
- Not to exceed $1.2 million each

## Center Components

***RFA Comparison***

- Project EXPORT Centers may adapt a modular concept of development, starting with at least 4 essential components for R24 and  5 essential components for P20 and P60.  Additional components can be added to achieve comprehensive status

## The EXPORT Center Components

- ADMINISTRATIVE CORE

- RESEARCH CORE

- SHARED RESOURCECORE

- PILOT RESEARCH CORE

- COMMUNITY OUTREACH CORE

- Mandatory: R24/P20/P60

- Mandatory: R24/P20/P60

- Mandatory: P20/P60

- HD EDUCATION

- Mandatory: R24

- Program Advisory Committee

- TRAINING OR MENTORING

- Training: P20/P60 Mentoring: R24

## Administrative Core

- Research Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- R24, P20, P60

**The Administrative Core:**
- Is responsible for the scientific and administrative leadership
- Coordinates and Integrates the Center components and activities
- Review and select pilot and feasibilities
- Review the utilization and quality of core resources
- Interact with the scientific and lay communities to develop relevant goals for the Center
- Interact with the administrative and scientifi8c leadership at the applicant institution to enhance the visibility and effectiveness of center as a focus on minority health/health disparities

- Training

## Research Component Core

- Administrative Core

- Research Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- P20, P60

**The Research Component Core:**
- Consists of a body of ongoing, interrelated research in an area of emphasis such as stroke, diabetes, etc. – projects should already be FUNDED from OTHER resources.
- Provides a mechanism for fostering interdisciplinary cooperation within a group of established investigators
- May include projects at other institutions, if collaborations exist with scientists at the applicant institution
- Provides an added dimension such as greater focus and increased cooperation, communication and collaboration

- Training

- Describe the research base (in tabular format and in detailed narrative form).  Quality of research has been established in peer review so the important aspects are: interactions and interrelationships of the research efforts; uses and benefits of core services; and plans to develop productive collaborations among Center investigators.

## Shared Resource Core

- Administrative Core

- Research Core

- Pilot Research/ Feasibility Study

- Community Outreach

- R24, P20, P60

**The Shared Resource Core:**
- Is a shared facility that provides a needed service to Center investigators enabling them to conduct their funded individual research projects more efficiently and/or more effectively.
- Cores should be designed to furnish a group of investigators with materials, techniques, determinations, instrumentations, and/or quality control to enhance research and contribute to cost effectiveness.
- A charge back mechanism is acceptable to help defray costs to the Center
- The types of cores that may be supported include but is not limited to: provision of a technology that lends itself to automation or preparation in large batches, complex instrumentation, animal preparation and care, clinical resources, service and training.

- Training

## Pilot Research/Feasibility Studies/Research Questions Core

- Administrative Core

- Research Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- R24, P20, P60

**The Pilot Research/Feasibility Studies/Research Questions Core:**
- Provides modes research support for a limited time to enable eligible investigators to explore the feasibility of a concept related to the mission of the EXPORT Center and generate sufficient data to pursue it through other funding mechanisms.
- The pilot and feasibility studies are intended to: provide initial support for new investigators; allow exploration of possible innovative new leads or new directions for established investigators in diabetes, and stimulate investigators from other areas to lend their expertise to research addressing minority health and health disparity issues.
- A minimum of two pilot and/or feasibility studies is recommended.

- Training

## Community Outreach/Information Dissemination Core

- Administrative Core

- Research Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- R24, P20, P60

**The Community Outreach and Information Dissemination Core**
- Has a three-fold focus:
- Development and dissemination of culturally sensitive health information directly related to the research of the Center or general health information presented in a culturally sensitive manner,
- Encouraging and equipping the community for potential participation in clinical studies and for partnering in the conduct of evidence based disease prevention and intervention activities, and
- Sponsorship of science education outreach activities (e.g., K-12 science programs).

- Training

## Training Core

- Administrative Core

- Research Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- P20, P60

**The Training Core**
- Training activities may be provided at the undergraduate, graduate, post-doctoral, and junior faculty level or a combination of two of such.
- For partnerships and consortia, training initiatives should represent true collaborations that function across institutional boundaries.
- Overall the training core must:
- -  Develop, implement and evaluate research development activities related to conducting health disparities research; provide training on issues related to developing cultural competence; increase the number of potential investigators from racial and ethnic minority and other health disparity groups; identify and facilitate interdisciplinary collaboration to promote the conduct of health disparities research.

- Training

## Mentoring

- Administrative Core

- Shared Resource Core

- Pilot Research/ Feasibility Study

- Community Outreach

- R24

**The Mentoring Core**
- Project EXPORT developmental activities are expected to provide mentoring for junior investigators by experienced researchers.
- New and established mentoring and training initiatives should represent true collaborations that function across institutional boundaries.

**Mandatory**

**Mandatory**

**Mandatory**

**Mandatory**

## Eligibility and Special Requirements

**Eligibility and Special Requirements**

## Organization/Administration

**Organization/Administration**

## Advisory Committee

**Advisory Committee**

## Planning and Evaluation

**Planning and Evaluation**

## Minimum/Maximum Components

***RFA Elements***

**Minimum/Maximum Components**

## Opportunities and Restrictions

***RFA Elements***

**Opportunities and Restrictions**

## Conditions of Award

- Awards may be made only if the applicant agrees that the grant will be expended:
- To train members of minority health disparity populations or other health populations as professionals of biomedical, behavioral and social sciences research
- To expand, remodel, renovate, or alter existing research facilities or construct new research facilities for the purpose of conducting minority health disparities research or other health disparities research

***RFA Elements***

## Administrative Guidelines

**Administrative Guidelines**

- Administrative guidelines will be available via the NCMHD website
-           http://www.ncmhd.nih.gov

## Letter of Intent

***RFA Elements***

**Letter of Intent**

## Application Receipt Date

**Application Receipt Date**

- Due Date – May 24, 2002
- Resource-Related Research Project (R24) RFA: MD-02-001
- Exploratory Grant (P20) RFA: MD-02-002
- Comprehensive Center Award (P60) RFA: MD-02-003