HEALTH COMMUNICATIONS IN CANCER CONTROL

Release Date:  May 29, 1998

RFA:  CA-98-014

P.T.

National Cancer Institute

Letter of Intent Receipt Date:  July 9, 1998
Application Receipt Date:  August 26, 1998

PURPOSE

The National Cancer Institute (NCI) invites submission of research grant
applications on health communications in cancer control.  These may include:  
(1) research on the use of "new media" (interactive digital media) in cancer
prevention and control, message development including, but not limited to, their
impact on primary and secondary cancer prevention and on cancer-related decisions
and (2) refinement and evaluation of communications systems to deliver cancer
control-related information.  Research on cognition, message framing and risk
communication also is within the scope of this Request for Application (RFA). 
Applications that include development and evaluation of health communications in
diverse populations (cultural, ethnic and economic diversity) are encouraged.

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, Health Communications in Cancer
Control, is related to the priority area of cancer.  Potential applicants may
obtain a copy of "Healthy People 2000" (Full Report:  Stock No. 017 001-00474-0
or Summary Report:  Stock No. 017 001-00473-1) through the Superintendent of
Documents, U.S. Government Printing Office, Washington, DC 20402-9325 (telephone
202-512-1800).

ELIGIBILITY REQUIREMENTS

Applicants may be submitted by domestic and foreign, for-profit and non-profit
organizations, public and private, such as universities, colleges, hospitals,
laboratories, units of State and local governments, health boards, public health
departments, territorial health departments (including the District of Columbia),
volunteer organizations, clinics, coalitions, and consortia. Teams of applicants
are encouraged. Among a team of applicants, one must be designated as the lead
applicant and assume responsibility for conduct of the project. Teams members may
include representatives from such disciplines as informatics, communications,
psychology, public health, graphic design, telecommunications, animation,
simulation, expert systems, marketing, and adult and childhood education. 
Foreign organizations are eligible to apply, and applications from domestic
organizations may include international components. Women and minority
investigators are encouraged to apply.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) individual research
project grant (R01).  Responsibility for the planning, direction, and execution
of the proposed project will be solely that of the applicant.  The total project
period for an application submitted in response to this RFA may not exceed four
years.

This RFA is a one-time solicitation for FY 99.  Future unsolicited competing
continuation applications will compete with all investigator-initiated
applications and be reviewed according to customary peer review procedures unless
additional re-issuances are announced.

The total cost for any application in any one-year budget period may not exceed
$500,000.  The anticipated award date for this RFA is April 1, 1999.

Awards and level of support depend on receipt of a sufficient number of
applications of high scientific merit.  Although this program is provided for in
the financial plans of the NCI, the award of grants pursuant to this RFA is
contingent upon the continuing availability of funds for this purpose.

FUNDS AVAILABLE

Approximately $2.5 million per year in total costs for four years will be
committed to fund applications that are submitted in response to this RFA.  It
is anticipated that six to eight new individual awards will be made through this
RFA.  The exact amount of funding awarded will depend on the quality of
applications and the availability of funds.

Applicants should provide a detailed time frame describing what specific
activities are to occur throughout the proposed grant period, justifying time
estimates.  Applicants may request support for up to four years.  The usual PHS
policies governing grants administration and management will apply.  Annual
awards will be made, subject to continued availability of funds and progress
achieved.

RESEARCH OBJECTIVES

Background

Communication is central to all phases of cancer control from primary prevention
and screening to surveillance and survivorship.  Most previous cancer control
research in this area has focused on traditional health communications, such as
generic or targeted print materials, videos and individual counselling.  However,
the field of communications has grown rapidly in the past few years, and new
media are becoming available to communicate with the public and at-risk
populations, many of whom have not been reached in the past (Consumer Health
Informatics, U.S. GAO, July, 1996).

Well-designed and well-delivered health communications have the capacity to reach
broader audiences and may be able to change health attitudes and behavior more
precisely.  Yet, as technology for communication expands, new challenges are
created.  For example, the public is deluged with health information and data,
much of it unevaluated.  Models to enable people to assess individual risks more
appropriately and to make informed decisions about primary, secondary and
tertiary prevention of cancer are needed.  Traditional channels for mass
communication are evolving into one-to-one (tailored) channels, creating
opportunities for broad scale dissemination of messages that are personalized to
particular characteristics, such as specific risk factors, readiness for change,
and health beliefs of users.

Well-executed studies have been conducted in tailored health communications (e.g.
Prochaska et al, 1993; Campbell et al, 1994; Skinner et al, 1994; Rimer and
Glassman, in press).  Yet, a number of important questions remain.  The next
generation of research should seek to refine such communications.  Improved
methodology in cancer communication would serve to better inform the public about
health, health risks, and options for prevention and treatment.  It would also
encourage informed decision-making about health-related behaviors and assist the
public in adopting healthier behaviors and lifestyles.  Such refinements in
communication may also be valuable for enhancing informed decision-making about
diagnostic and treatment options.

The revolution in digital communications and bioinformatics has created new
channels and opportunities to deliver health information to specific targets. 
The potential for reaching a broader segment of the population more rapidly
requires that there be efficient management and timely dissemination of new
knowledge about effective biomedical and behavioral interventions emerging from
research.

Research Scope and Goals

Communication interventions are an integral component of multi disciplinary,
multi-component cancer control efforts.  Proposed studies could include the
development and testing of personal interactive communication, computer
information and/or decision making systems to enhance message delivery and impact
in cancer control.  The research proposed should be innovative and when possible,
should employ cost-effectiveness analyses and discussion of the application and
diffusion of trial results.  The areas of research outlined below are not
inclusive but are described to give applicants direction for the types of
research that the NCI is interested in stimulating.  Studies are invited across
the spectrum of cancer control, ranging from prevention and early detection to
informed decision-making and survivorship.  Research can range from basic (pre-
intervention studies to evaluate message components and delivery) to intervention
studies and broad-scale dissemination.

--Research that identifies and evaluates the optimal communication strategies to
reach underserved populations (e.g., elderly, rural, ethnic minorities, low
literate); Basic laboratory research to examine the impact of specific elements
of tailored communications, e.g., effect of graphic style, format, degree of
personalization, message style, etc.;

--Studies that examine message framing and its influence on decision making and
behavior; Studies on risk communication in cancer control, including how
individuals interpret and attend to risk information and how practitioners
explain and interpret risk to the public, individuals at high risk for cancer and
patients;

--Randomized trials to address unanswered questions in tailored message
technology, including designs and enhanced measurement methods that will enable
researchers to answer fundamental questions about what tailoring strategies are
most effective, under what conditions, and for whom;

--Research to examine use of networks of communication, automated response
systems and other technologic advances for use in behavioral change programs;

--Collaboration with the Cancer Information Service (CIS) and other organizations
to evaluate various communication strategies; and

--Studies that evaluate the effectiveness of the World Wide Web and the ability
of the "new media" to reach specific population segments in reaching objectives
related to cancer control.

Other Requirements

In addition, for each year of proposed NCI support, the applicant should include
travel for a two-day meeting to Bethesda for the Principal Investigator and up
to one additional staff person to attend the annual NCI health communication and
cancer control grantee meeting.  The travel expense should include air fare,
ground transportation and per diem for each attendee.  The meeting will not
require a registration fee.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and their
subpopulations must be included in all NIH supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided that inclusion is inappropriate with
respect to the health of the subjects or the purpose of the research.  This
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public
Law 103-43).

All investigators proposing research involving human subjects should read the
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of March 28, 1994
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23,
Number 11, March 18, 1994.

Investigators also may obtain copies of the policy from the program staff listed
under INQUIRIES.  Program staff may also provide additional relevant information
concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit, by July 9, 1998, a letter of intent
that includes a descriptive title of the proposed research, 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.  Although a letter of intent
is not required, is not binding, and does not enter into the review of subsequent
applications, the information that it contains allows NCI staff to estimate the
potential review workload and to avoid conflict of interest in the review.

The letter of intent is to be sent to:

Sherry Mills, M.D., M.P.H.
Division of Cancer Control and Population Sciences
National Cancer Institute
6130 Executive Boulevard, Room 232
Bethesda, MD  20892-7332
Rockville, MD  20852 (for express/courier service)
Telephone:  (301) 496-8520
FAX:  (301) 480-6637
Email: Sherry_Mills@nih.gov

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS 398 (rev.
5/95).  These forms are available at most institutional offices of sponsored
research; from the Division of Extramural Outreach and Information Resources,
National Institutes of Health, 6701 Rockledge Drive MSC 7910, Bethesda, MD
20892-7910 telephone 301/710-0267, email: email: Grantsinfo@nih.gov; and from the
program administrator listed under INQUIRIES.

The RFA label available in the PHS 398 (rev. 5/95) 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 in Section 2 of the face page of the application form and
the YES box must be marked.

All requirements with regard to type, size, page limitations, appendix material,
etc. must be followed or applications will be returned without review.  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 (with
appendices) must also be sent to:

Mrs. Toby Friedberg
Division of Extramural Activities
National Cancer Institute
6130 Executive Boulevard, Room 6362
Bethesda, MD  20892
Rockville, MD  20852 (for express/courier service)

Applications must be received by August 26, 1998.  If an application is received
after the application receipt date, it will be returned to the applicant without
review.  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.  The CSR
will not accept any application that is essentially the same as one already
reviewed. This does not preclude the submission of substantial revisions of
applications already reviewed, but such applications must include an introduction
addressing the previous critique.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness by the CSR and
responsiveness by the NCI.  Incomplete and/or non-responsive applications will
be returned to the applicant without further consideration.  Those applications
that are complete and responsive will be evaluated in accordance with the
criteria stated below for scientific/technical merit by an appropriate peer
review group convened by the Division of Extramural Activities, NCI.

As part of the initial review, all applications will receive a written critique
and undergo a process in which only those applications deemed to have the highest
scientific merit, generally the top half of applications under review, will be
discussed, assigned a priority score and receive a second level of review by the
National Cancer Advisory Board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health.  In the
written review, comments on the following aspects of the application will be made
in order to judge the likelihood that the proposed research will have a
substantial impact on the pursuit of these goals.  Each of these criteria will
be addressed and considered in the assignment of the overall score.

1.  Significance: Does this study address an important problem?  If the aims of
the application are achieved, how will scientific knowledge be advanced? What
will be the effect of these studies on the concepts or methods that drive this
field?

2.  Approach: Are the conceptual framework, design, methods and analyses
adequately developed, well-integrated, and appropriate to the aims of the
project?  Does the applicant acknowledge potential problem areas and consider
alternative tactics?

3.  Innovation:  Does the project employ novel concepts, approaches or methods? 
Are the aims original and innovative?  Does the project challenge existing
paradigms or develop new methodologies or technologies?

4.  Investigator: Are the investigators appropriately trained and well suited to
carry out this work?  Is the work proposed appropriate to the experience level
of the principal investigator and other researchers (if any)?  Does the team
include the multidisciplinary expertise required to conduct the research?

5.  Environment: Does the scientific environment in which the work will be done
contribute to the probability of success?  Do the proposed experiments take
advantage of unique features of the scientific environment or employ useful
collaborative arrangements?  Is there evidence of institutional support?

In addition to the above criteria, in accordance with NIH policy, all
applications will also be reviewed with respect to the following:

6.  Adequacy of plans to include both genders, and minorities and their subgroups
as appropriate for the scientific goals of the research.  Plans for the
recruitment and retention of subjects will also be evaluated.

7.  The adequacy of the proposed provisions for the protection of human subjects
and animal welfare and the safety of the research environment.

8.  The reasonableness of the proposed budget and duration of the project in
relation to the proposed research.

AWARD CRITERIA

Applications found to have significant and substantial merit will be considered
for funding by the following:

o  priority score
o  availability of funds
o  programmatic priorities

INQUIRIES

Written, telephone and, especially, e-mail inquiries concerning this RFA are
encouraged. The opportunity to clarify any issues or questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

Sherry Mills, M.D., M.P.H.
Division of Cancer Control and Population Sciences
National Cancer Institute
6130 Executive Boulevard, Room 232
Bethesda, MD  20892-7332
Rockville, MD  20852 (for express/courier service)
Telephone:  (301) 496-8520
FAX:  (301) 480-6637
Email:  Sherry_Mills@nih.gov

Direct inquiries regarding fiscal matters to:

Mr. Bill Wells
Grants Administration Branch
National Cancer Institute
6120 Executive Boulevard, Room 243
Bethesda, MD  20892
Telephone:  (301) 496-7800 ext. 250
FAX:  (301) 496-8601
Email:  ww14j@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No.
93.399, Cancer Control.  Awards are made under authorization of the Public Health
Services Act, Title IV, Part A (Public Law 78-410, as amended by Public Law
99-158, 42 USC 241 and 285) and administered under PHS grants policies and
Federal Regulations 42 CFR 52 and 45 CFR Part 74 and Part 92.  This program is
not subject to the intergovernmental review requirements of Executive Order 12372
or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a smoke-
free workplace and promote the non-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.

References

Prochaska JO, Velicer WF, Rossi JS, et al.  Standardized , individualized,
interactive and personalized self-help programs for smoking cessation.  Health
Psychol 1993; 12 (5):399-405.

Campbell MK, DeVellis BM, Strecher VJ. Ammerman AS, DeVellis RF, Sandler, RS. 
The impact of message tailoring on dietary behavior change for disease prevention
in primary care settings.  Am J Public Health 1994;84(5):783-787.

Skinner CS, Strecher VJ, Hospers H.  Physician recommendations for mammography:
do tailored messages make a difference? Am J Public Health 1994;84(1):43-49.

Rimer BK, Glassman, B.  Tailoring communications for primary care settings. 
Methods of Information in Medicine, in press.

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