Centers for Disease Control and Prevention: Use of Special Interest Projects to Fund Prevention Research Centers
Published: 2017-09-07T00:00:00

Fast Facts:
CDC uses the Special Interest Project program to offer supplemental funding to its 26 Prevention Research Centers—which conduct public health research at universities around the country.
We found that CDC uses this supplemental funding for research projects that involve community-based organizations and community members, and that such projects cover a variety of topics (e.g., cancer prevention, healthy brain research).
Stakeholders said that the main advantage of limiting such funding to Prevention Research Centers is the ability to rapidly initiate research, while disadvantages include potentially reduced access to outside expertise.

Highlights:
section_title: Why GAO Did This Study
paragraphs: CDC, an agency within HHS, created the SIP program in 1993 as a supplemental funding mechanism to support health promotion and disease-prevention research being done at its PRCs. Currently, there are 26 PRCs. In fiscal years 2014 through 2016, CDC awarded more than $40 million for SIPs. SIP topics vary from year to year but are to be aligned with public health priorities, such as the Healthy People 2020 Objectives—HHS's 10-year national objectives for improving Americans' health. SIPs are sponsored and primarily funded by CDC organizational units, referred to as sponsoring units.
House Report 114-195 included a provision for GAO to review the SIP program. This report describes (1) what research CDC chooses to fund through the SIP mechanism, and (2) what have been identified as advantages and disadvantages of SIP eligibility being limited to PRCs. GAO reviewed documents from CDC and analyzed CDC data on SIPs awarded in fiscal years 2014 through 2016. GAO also interviewed CDC officials, including officials from 5 of the 10 sponsoring units that together accounted for over 90 percent of SIP funding during this time period, officials from 4 PRCs with varying experience with SIPs, and 4 organizations with knowledge of prevention research.
section_title: What GAO Found
paragraphs: The Centers for Disease Control and Prevention (CDC) uses the Special Interest Project (SIP) mechanism to fund community-based prevention research that would benefit from a multidisciplinary group of researchers. SIPs are supplemental funding awards that focus on topics of interest or gaps in knowledge or research and can also support the development of state and local public health interventions and policies. SIPs are only available to CDC's Prevention Research Centers (PRC)—selected academic health centers at universities with schools of public health or medical schools with residency programs in preventive medicine.
CDC officials said that they would choose the SIP mechanism when the research they want to fund is intended to involve community-based organizations or members of the community. They also use SIPs when they seek access to researchers who have established partnerships with diverse population groups across the country. They would not choose the SIP mechanism when the research they want to fund is not focused on public health prevention, including research that is clinical or laboratory-based; would be better suited for an entity other than an academic health center; or would be better funded through a contract to allow CDC to direct the research protocol. CDC's collaborations with experts in the field—including those at other federal agencies—help to inform its development of the research funding opportunities offered through SIPs. For example, CDC officials use information they learn through participation in multiagency workgroups and advisory committees to identify gaps in knowledge that SIP funding could help to address. CDC officials also stated that this collaboration can also help to avoid potential duplication of research.
The key advantage of SIPs being limited to PRCs is the ability to rapidly initiate research, according to officials with whom GAO spoke—including officials from CDC, PRCs, and organizations with knowledge of prevention research. Factors cited as contributing to this ability included the research infrastructure and community relationships already established at the PRCs. Officials from CDC and outside organizations also identified a few potential disadvantages to limiting eligibility for SIPs, including the potential for reduced access to expertise from researchers or others who are not affiliated with the universities in which PRCs are located, although some noted that PRCs may bring in outside expertise through subcontracts with other entities.
The Department of Health and Human Services (HHS) provided technical comments on a draft of this report, which GAO incorporated as appropriate.

section_title: Letter
paragraphs: The Centers for Disease Control and Prevention (CDC) created the  Special Interest Project (SIP) program in 1993 to be a supplemental  funding mechanism for its Prevention Research Center (PRC)  program. The PRC program was authorized by Congress and established  by CDC to fund research and demonstration projects at academic health  centers. CDC funds PRCs—which are centers at universities that must  have accredited schools of public health or schools of medicine with a  preventive medicine residency program—every 5 years through a  competitive process. For the current 5-year project period, which runs  from fiscal year 2014 through fiscal year 2019, CDC is funding 26 PRCs.
SIPs, which are only available to researchers affiliated with the  universities in which the PRCs are located, are cooperative agreements  to provide additional funding for health promotion and disease prevention  research projects that focus on a topic of interest or a gap in knowledge  or research. SIPs can also support the development of state and local  public health interventions and policies. SIP topics vary from year to year  but are to be aligned with public health priorities, such as the Healthy  People 2020 Objectives—the Department of Health and Human Services’  (HHS) 10-year national objectives for improving the health of Americans.
SIPs are sponsored and primarily funded by CDC organizational units,  which we refer to as sponsoring units; as of fiscal year 2016, there are 10  CDC sponsoring units that have funded SIPs during the current PRC  project period. The number of SIPs varies from year to year, with at least  some providing for multiple years of funding; the number of PRCs funded  per SIP (i.e., the number of awards) and the funding amounts per award  also vary. Total funding provided to date for the SIPs awarded in fiscal  years 2014 through 2016—including initial funding and continuation  funding—was $40.7 million.
House Report 114-195, which accompanied the Departments of Labor,  Health and Human Services, Education, and Related Agencies  Appropriations Bill, 2016, included a provision for us to review certain  aspects of the SIP program. This report describes:  1.  what research CDC chooses to fund through the SIP mechanism, and  2.  what have been identified as the advantages and disadvantages of  SIP eligibility being limited to PRCs.
To describe what research CDC chooses to fund through the SIP  mechanism, we reviewed the funding opportunity announcements (FOA)  for the SIP program for fiscal years 2014 through 2016, and the fiscal  year 2014 FOA for the PRC awards. In addition, we reviewed CDC data  on SIPs, including the number of SIPs, the number of SIP awards, and  SIP funding by CDC sponsoring unit and by PRC, for fiscal years 2014  through 2016, the most recent years for which funding had been  awarded. To assess the reliability of these data, we interviewed CDC  officials who prepared the data for us, compared the data to publicly  available information on CDC’s website, and tested the data for missing  or erroneous values. We determined that the data we used were  sufficiently reliable for the purposes of our reporting objectives. We  interviewed CDC officials from the PRC program office—housed in the  National Center for Chronic Disease Prevention and Health Promotion  (NCCDPHP)—to understand their role in administering the SIP program.  We also interviewed officials from 5 of the 10 CDC sponsoring units that  funded SIPs in fiscal years 2014 through 2016 about why they choose the  SIP mechanism over other mechanisms, among other topics. We  selected these units because they sponsored the largest number of SIPs  and greatest amount of SIP funding—together, they accounted for 88  percent of all SIPs and 93 percent of SIP funding during this time period.  To corroborate their statements, we reviewed available documentation  provided by CDC officials, including guidance provided by the PRC  program office to sponsoring units about developing SIPs. We also  reviewed information provided by CDC sponsoring units on their  processes for gathering information on gaps in knowledge and topics of  interest that can be developed into SIP research topics, including their  collaboration with federal and nonfederal experts. We also reviewed  relevant laws, regulations and agency policies for the SIP and PRC  programs.
To describe what have been identified as the advantages and  disadvantages of SIP eligibility being limited to PRCs, we conducted  interviews with the CDC officials described above and officials from a  nongeneralizable selection of four PRCs. We selected the four PRCs to  obtain a variety of experiences with the SIP program in fiscal years 2014  through 2016. Our selection resulted in: a PRC that had applied for, but  not been awarded any SIPs; the PRC with the greatest number of SIP  awards; the PRC that was awarded the greatest amount of funding for an  individual SIP; and a first-time PRC that received SIP funding. We also  interviewed officials from four organizations with knowledge of public  health research and familiarity with the academic institutions conducting  this work (referred to in this report as outside organizations) to obtain their  perspective on the advantages and disadvantages of the limited eligibility  for SIPs. We also used our review of the SIP and PRC FOAs to  supplement the information obtained during our interviews.
We conducted this performance audit from October 2016 to September  2017 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: To help fulfill its role as the nation’s health protection agency, HHS’s CDC  conducts and supports research, including prevention research.  Prevention research includes applied public health research that develops  and evaluates health promotion and disease prevention and control  strategies that are community- and population-based.
subsections: section_title: CDC’s PRC Program and SIP Eligibility
paragraphs: Through legislation enacted in 1984, Congress authorized, and CDC later  established, the PRC program to fund health promotion and disease- prevention research. The legislation mandated that the PRCs to be  funded be located at academic health centers capable of providing a  multidisciplinary faculty with expertise in public health, relationships with  professionals in other relevant fields, graduate training and demonstrated  curricula in disease prevention, and a capability for residency training in  public health or preventive medicine. The PRCs, the first of which were  funded in 1986, also serve as demonstration sites for the use of new and  innovative applied public health research and activities for disease  prevention and health promotion. The PRC program is administered by  CDC’s NCCDPHP. CDC makes its PRC awards through a competitive  process; there are currently 26 PRCs, located in 24 states, funded for  fiscal years 2014 through 2019.
Funded PRCs are able to compete for SIPs, which were created by CDC  in 1993 to provide supplemental funding to the PRCs to design, test, and  disseminate effective applied public health prevention research  strategies. According to CDC, eligibility for SIPs is limited to PRCs  because the centers are “uniquely positioned to oversee, coordinate, and  perform applied public health research that promotes the field of health  promotion and disease prevention research due to their established  relationships with multidisciplinary faculty and community partners.”
section_title: SIP Award Process and Public Disclosure
paragraphs: Subject matter experts (SME) within CDC sponsoring units propose  potential SIPs each year, depending on unit needs—e.g., particular  research gaps that have been identified—and available funding. After  being approved by the leadership of the sponsoring unit, the sponsoring  units’ proposals are reviewed internally by NCCDPHP and others before  being included in a SIP FOA. The SIP FOA is assembled by NCCDPHP’s  extramural research group, and when complete, is posted publicly on the  grants.gov website. SIP applications are subject to an external peer  review process, as well as a secondary internal review by CDC officials.  SIP awards are generally made on the last day of the fiscal year.  Sponsoring units fund both individual SIPs, which are awarded to one or  more PRCs to work independently on a particular research topic, and  thematic network SIPs, which are awarded to multiple PRCs to work  collaboratively on a research agenda related to a specific health issue,  such as cancer prevention or brain health.
In fiscal years 2014, 2015, and 2016, CDC announced the availability of  51 SIPs—of which 43 were funded. The 43 funded SIPs resulted in a  total of 76 awards to 22 of the 26 PRCs. (See appendix 1 for detailed  information on the SIPs awarded in fiscal years 2014 through 2016,  including information on SIPs awarded by sponsoring unit, SIP funding by  PRC, and a complete listing of all SIPs awarded during this period.)
CDC publicly discloses information on SIP awards on its website.  Specifically, CDC has a PRC project database on its website that, as of  July 2017, included information on SIPs from fiscal years1999 through  2015, as well as other information related to the PRCs. The project  database includes the SIP number, project title, principal investigator,  PRC funded, and the CDC sponsoring unit. It does not include the  amount of the funding.
section_title: CDC Chooses the SIP Mechanism to Fund Community- Based Prevention Research
subsections: section_title: CDC Chooses the SIP Mechanism to Fund Research Focused on Public Health Prevention Involving Community Participation
paragraphs: In general, CDC officials we spoke with told us they will choose the SIP  mechanism when seeking to fund prevention research that is community- based and would benefit from having access to a multidisciplinary group  of researchers. Specifically, CDC officials from most of the sponsoring  units we spoke to told us that they use the SIP mechanism when  community participation is important to the research. For example, one  sponsoring unit used a SIP for the development and testing of an  integrated comprehensive communication strategy to promote vaccination  for the human papilloma virus in the United States. The SIP was focused  on developing strategies that engaged local or regional health systems,  community-based organizations, and state health departments as key  community partners, in order to enhance the acceptability of the  vaccination among parents with vaccine-eligible children and to increase  the likelihood that a provider would recommend the vaccination. CDC  officials from one sponsoring unit also told us they use the SIP  mechanism when they need to engage community leaders and members  of the public in order to answer the research questions. For example,  CDC used the SIP mechanism to fund a research project focused on  enhancing the knowledge, skills, and capacity of community health  advocates and leaders from community-based organizations, with the  goal to provide participants with the skills necessary to assess local  community health needs in order to improve community health. According  to CDC, an important aspect of the research was the evaluation of  whether there was an increase in the skills and leadership capacities of  participants and their influence on local improvements in their  communities.
In addition, CDC officials told us that they choose the SIP mechanism to  conduct research when seeking to access researchers who have  established partnerships with diverse population groups across the  country. PRCs are located across the United States and are expected to  have cultivated relationships with their local communities. For example,  one sponsoring unit used a SIP to fund research on the barriers to  colorectal cancer screening among South Central Asian immigrants,  primarily Indians and Pakistanis, who have been shown to have low  screening rates. The purpose of the research was to inform the  development of culturally relevant strategies to increase colorectal  screening. As such, to be awarded the SIP, a PRC had to demonstrate  that it had established relationships within the South Central Asian  community and an ability to recruit from these populations.
In contrast, CDC officials explained that they would not choose the SIP  mechanism if the desired research would be better suited for an entity  other than an academic health center. For example:
Officials from one sponsoring unit told us that a different mechanism  was used for a project testing obesity prevention and management  strategies because the project required working directly with health  care service providers in the community, such as federally qualified  health centers.
Officials from another sponsoring unit chose not to use a SIP for a  project to evaluate vaccine impact on recurrent respiratory  papillomatosis (a disease in which tumors grow in the respiratory  tract). This research was being conducted by the providers who care  for the patients, as opposed to academic researchers.
CDC officials provided examples of other instances when they would not  use a SIP, and instead choose another mechanism to support the desired  research. Specifically, officials from one sponsoring unit told us that when  conducting a research project related to cervical cancer, they did the work  through a contract in order to allow the SME to direct the research  protocol, which included collaboration with organizations that maintained  cancer data, as well as the deliverables and timeline for completion of the  work. Sponsoring unit officials also told us that they will not choose the  SIP mechanism when the research they want to fund is not focused on  public health prevention, such as when the research is clinical or  laboratory based, or when the timing of the research does not align with  the PRC funding cycle (e.g., a longitudinal study or a study that would  cross two PRC funding cycles).
section_title: Collaboration with Federal and Nonfederal Experts Informs Development of SIP Funding Opportunities and Reduces Potential for Unnecessary Duplication
paragraphs: CDC officials told us that CDC SMEs’ relationships and collaboration with  experts in the field—including federal and nonfederal experts—help  inform the development of the research funding opportunities made  available through SIPs, as well as other mechanisms. In our prior work,  we found that interagency collaboration, which can include information  sharing and communication among federal experts, may reduce the  likelihood of unnecessary duplication.
According to officials from all of the sponsoring units we spoke with,  SMEs have developed collaborative relationships with federal and  nonfederal experts in their fields; these relationships develop through  SMEs’ participation in workgroups, advisory committees, and joint  projects, as well as through informal interactions at in-person meetings  and conferences. (See table 1 for examples of the workgroups and  advisory committees in which CDC SMEs participate.) These interactions,  as well as the SME’s review of the scientific and nonscientific literature,  are used to determine gaps in knowledge and inform the research  proposed to be funded through SIPs or other mechanisms.
CDC SMEs’ collaboration with federal and nonfederal experts may lead to  the development of specific research projects that are funded through a  SIP. For example:
SMEs from one sponsoring unit identified a series of research gaps  that existed within skin cancer prevention while working on the  Surgeon General’s Call to Action to Prevent Skin Cancer Report with  multiple federal agencies, including the Food and Drug Administration,  the National Institutes of Health’s (NIH) National Cancer Institute, the  Environmental Protection Agency and the Office of the Surgeon  General. CDC developed a SIP to address one of these gaps— assessing the knowledge, attitudes and beliefs about skin cancer in  order to develop and test communication strategies for skin cancer  prevention, specifically for adults aged 18 to 49.
SMEs from another sponsoring unit participate in the Interagency  Coordinating Committee on the Prevention of Underage Drinking with  15 federal partners, including the Substance Abuse and Mental Health  Services Administration, Federal Trade Commission, Department of  Justice, and NIH’s National Institute on Alcohol Abuse and  Alcoholism. According to CDC, this group meets regularly to discuss  their work and efforts to address prevention of underage drinking.  Based on this collaboration and the review of other resources,  including research projects and reports by committee members, CDC  SMEs determined there was a gap in knowledge related to monitoring  youth exposure to alcohol marketing on the Internet, and developed  and awarded a SIP in 2014 to address this issue.
In 2011, CDC SMEs hosted an expert conference—including federal  and nonfederal researchers, health care providers, and  representatives from advocacy groups—to discuss how patients and  health care providers can communicate effectively before, during, and  after prostate cancer screenings. Recommendations from this  conference resulted in a 2014 SIP focused on the development of a  multimedia decision aid to help patients and their family members  understand treatment options after a positive prostate cancer  diagnosis.
Collaboration with experts may also increase the resources available for a  specific research project. For example, officials from the CDC unit that  sponsors the National Cancer Prevention and Control Research Network  SIP told us that the network is jointly funded with NIH’s National Cancer  Institute. This joint funding allows for an expanded pool of resources, and  officials stated that the network is able to achieve more than any  individual PRC could achieve on its own.
CDC officials told us that the knowledge gained through coordination and  information sharing also mitigates the potential for duplication of research  efforts. For example, officials from one sponsoring unit told us that as a  part of their ongoing discussions with NIH on sexually transmitted disease  prevention, they learned of research NIH was conducting that was related  to a SIP that CDC planned to fund. CDC decided not to fund the SIP and  instead entered into a joint funding arrangement with NIH to address its  research needs. The joint funding arrangement allowed CDC and NIH to  expand the number of sites involved in the research NIH already had  underway.
section_title: Ability to Rapidly Initiate Research Cited as Key Advantage of Limited Eligibility for SIPs; Disadvantages Included Potentially Reduced Access to Outside Expertise
paragraphs: The main advantage of limiting eligibility for SIPs to the PRCs is the ability  to rapidly initiate high-quality research, due to the infrastructure and  relationships the PRCs have in place, according to officials from CDC,  outside organizations, and PRCs. For example, officials we spoke with  from one PRC told us that they typically learn from CDC if their  application for a SIP has been successful in August of a given year, and  awards are made at the end of September, with the expectation that the  research should begin shortly thereafter. These officials added that  because many SIPs are only providing funds for one or two years, there  is no time to waste in getting the research up and running. Officials from  one outside organization noted that this faster turnaround in getting the  research started can result in faster publication of results.
Officials from CDC and others told us that PRCs have infrastructure in  place to do multidisciplinary research, which an official from one outside  organization told us includes the ability to manage federal funds and  recruit study participants. This infrastructure contributes to the speed with  which PRCs can start a SIP. For example, officials from one CDC  sponsoring unit told us that a PRC’s existing infrastructure means that it is  not starting from scratch when it conducts research through a SIP. In  addition, a representative from one outside organization said that it is a  good use of federal resources to continue to invest in federally supported  infrastructure—as in the case of offering supplemental funding to PRCs in  the form of SIP awards.
In addition to research infrastructure, officials also told us that PRCs have  established relationships with community partners. One outside  organization told us that these relationships are particularly important for  prevention research, which often involves working with populations who  may be reluctant to participate in research. Research has confirmed the  need for community engagement when studies include disadvantaged  groups. Specifically, a systematic review of the literature on strategies for  increasing participation of disadvantaged groups in research concluded  that researchers need to operate via community partnerships, because  they can increase trust among the study population. Similarly, one  sponsoring unit told us about the importance of the PRCs’ credibility in  the neighborhoods where the research is being done. Given this, for  some SIPs, the FOA explicitly requires PRCs to outline their partnerships  with community organizations in their applications or notes that  descriptions of these relationships will be considered when applications  are scored by reviewers. For example, the fiscal year 2015 FOA for a SIP  that was to identify means for increasing screening rates for breast and  cervical cancer in Muslim women asked that applicants “describe and  provide evidence (such as supporting letters and publications) of  sufficient institutional, community and other necessary support for  carrying out this project.”
In addition, officials from CDC and outside organizations noted that there  are benefits of having eligibility limited to entities that have already been  vetted, such as an increased likelihood of the research being successful.  To become a PRC, the eligible academic institutions must go through a  competitive peer review process, through which they are evaluated based  on their ability to contribute to improved community and population health,  impact public health programs and practice, and advance the field of  public health promotion and disease prevention, among other things.  Because of this vetting, an official from one outside organization told us  that PRCs are likely to be successful in their work—mitigating the risk  faced were an award to be made to an unknown entity. An official from  another outside organization noted that CDC sponsoring units work  closely with the PRCs on implementing the SIPs, and it is beneficial that  the PRCs are “known entities” who have established relationships with  CDC.
Officials from CDC and outside organizations identified a few potential  disadvantages to limiting eligibility for SIPs, including the potential for  reduced access to expertise outside of the PRCs and the risk of being  unable to conduct desired research at the desired time. Specifically,  officials from outside organizations told us that there may be reduced  access to the expertise of researchers from other universities or other  entities. CDC officials and officials from PRCs said that PRCs have the  ability to bring in the expertise from outside the PRC institution through  subcontracts with other entities, which could help alleviate this concern.  For example, for a SIP on skin cancer prevention messaging, the PRC  officials at the University of Pennsylvania told us they had multiple  subcontracts, including one with a researcher at another university with  expertise on indoor tanning.
Officials from two outside organizations stated that there is a missed  potential for innovation and new approaches if new entities are not  eligible for SIPs or added to the pool of PRCs. Although there is a  competition for PRCs every 5 years, the PRCs have been fairly stable in  recent years—2 new PRCs were added in fiscal year 2014, while more  than half (15 of 26) of the current PRCs have been continuously funded  by CDC for at least 15 years.
Because SIPs are only announced once per year and are awarded at the  end of the fiscal year, one other potential disadvantage of SIPs’ limited  eligibility is the risk that CDC’s desired research may not be conducted, or  may not be able to be conducted at the desired time. If the research  project is ultimately not funded through the SIP, there is not sufficient time  within the fiscal year to pursue an alternative mechanism. CDC  sponsoring unit officials described instances where they did not receive  any applicants or did not receive enough qualified applicants for individual  SIPs and thus were not able to fund a SIP or made fewer awards than  planned. In fiscal years 2014 through 2016, 5 of 51 SIPs included in the  FOAs were ultimately not funded because they received no applications  or the applications received were not a good fit for the desired project. For  an additional 2 SIPs, the sponsoring units funded fewer awards than  planned because they did not receive enough quality applications.
section_title: Agency Comments
paragraphs: We provided a draft of this report to HHS for review. HHS provided  technical comments, which we incorporated as appropriate.
We are sending copies of this report to the Secretary of the Department  of Health and Human Services, the Director of the Centers for Disease  Control and Prevention, and other interested parties. In addition, the  report is available at no charge on the GAO website at  http://www.gao.gov.
If you or your staff have any questions about this report, please contact  me at (202) 512-7114 or crossem@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made key contributions to this  report are listed in appendix II.
section_title: Appendix I: Information on Centers for Disease Control and Prevention (CDC) Special Interest Projects (SIPs)
paragraphs: Appendix I: Information on Centers for Disease  Control and Prevention (CDC) Special Interest  Projects (SIPs)
Tables 2, 3, and 4 below present data on SIPs awarded in fiscal years  2014 through 2016.
section_title: Appendix II: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Michelle B. Rosenberg (Assistant  Director), Julie T. Stewart (Analyst-in-Charge), and Romonda McKinney  Bumpus made key contributions to this report. Also contributing were  Sam Amrhein and Jacquelyn Hamilton.