Fellowships, grants, & awards. (Announcements).

Centers for Children's Environmental Health and Disease Prevention Research

A federal executive order of 21 April 1997, "Protection of Children from Environmental Health Risks and Safety Risks," charges agencies to consider special environmental risks to children in their activities. Accordingly, the NIEHS and the U.S. Environmental Protection Agency (EPA) invite grant applications for centers that will conduct multidisciplinary basic and applied research in combination with community-based research projects on environmental threats to children's health and translate those research findings to public policy, community needs, and information for the health care community and for the general public.

Awards in this program will 1) provide for interactions among basic, clinical, and behavioral scientists to establish state-of-the-art research programs addressing environmental contributions to children's health and disease; 2) support a coordinated program of research/prevention centers pursuing high-quality research in environmental aspects of children's disease, with the ultimate goal of facilitating and accelerating translation of basic science knowledge into clinical applications or intervention strategies that can be used to reduce the incidence of environmentally related diseases in childhood; 3) develop fully coordinated programs that incorporate exposure assessment and health effects research with development and validation of risk management and health prevention strategies; 4) encourage the translation and application of research findings to the prevention and clinical decision making arenas and give information to the communities and policy makers that most need it to protect children's health; and 5) establish a national network that fosters communication, innovation, and research excellence with the ultimate goal of reducing the burden of morbidity among children as a result of exposure to harmful environmental agents.

Data will be generated in a multitude of scientific disciplines in order to understand the impact of chemical and other exposures on the fetus and child as it relates to brain and other organ systems growth and development through young adulthood. Specifically, disease areas such as respiratory diseases, neurodevelopment and neurobehavior, childhood cancers, birth defects, and other conditions can be included for study.

This initiative builds upon a related request for applications (RFA) that resulted in the creation of 12 Centers for Children's Environmental Health and Disease Prevention Research. The prior RFA emphasized similar research foci: respiratory disorders, growth and development, and learning and behavior, including developmental disorders. Recompetition of the existing program emphasizes the need for continued research in all of the above areas, but expands the role of translational research and community outreach that will move the research from the experimental and population laboratory to the prevention and clinical decision making arenas and to the general public. Scientifically, the focus of the continuing program reemphasizes the importance of exploring the unique susceptibilities of children that put them at risk of developing illness in early life. These susceptibilities include genetic susceptibility, susceptibility due to poverty and poor nutritional status, and increased risk due to strained social and behavioral supports and inadequate access to medical care. Center research should fill existing gaps in our understanding of the complex interactions between genes and the environment, including chemical, physical, biological, social, behavioral, and nutritional factors in the development of common childhood diseases.

Collaborative multidisciplinary research approaches are required to explore the dynamic interaction of children with their environment. This center program therefore emphasizes integration of laboratory and population science while applying community-based participatory research (CBPR) strategies. Centers are expected to have fully coordinated programs that incorporate exposure assessment and health effects research with development and validation of risk management and health prevention strategies. Moreover, involvement of the affected community in planning, implementing, and evaluating a CBPR effort is essential. In this regard, it is required that each center has a CBPR project that capitalizes on partnerships between researchers and community-based organizations, including local affiliates of organizations that advocate on behalf of childhood health concerns or represent environmental concerns in their communities. Each center should create a structure to carry out research that is of importance to the affected community. This work can be community-based etiologic research, community-based exposure assessment research, or community-based prevention/intervention research.

In this competitive round, we are adding a distinct activity to each center, the Community Outreach and Translation Core, the purpose of which is to develop, implement, and evaluate strategies to translate and apply the scientific findings of the center into information for the public, policy makers, and clinical professionals to use to protect the health of children.

Each center should identify a central theme or focus of its research effort so that the subprojects involved are responsive to the specific research area of children's environmental health supported by this grant program. Furthermore, the translational objective of this program requires the applicant to include at least one subproject that includes research of a community-based participatory nature and to develop a Community Outreach and Translation Core in order to support the translation and application of this research in the community and in the policy and clinical arenas.

The long-range goals of this program are twofold: to stimulate new and expand on existing research on the role of environmental exposures in the etiology and prevention of prevalent disorders in children, and to promote translation of basic research findings into applied intervention and prevention methods, thereby enhancing awareness among children, their families, and health care practitioners regarding detection, treatment, and prevention of environmentally related diseases and health conditions.

A spectrum of scientific approaches is expected to create a truly multidisciplinary working environment where experimental research can inform population-based research and vice versa. These disciplines would include mechanistic research including pathophysiology of target-organ systems, toxicological research, molecular and cellular sciences, clinical research, public health research including epidemiology, exposure assessment and remediation, behavioral sciences, economic research, and social policy research. The application must contain a minimum of three research projects, one of which must be a CBPR project and one a laboratory-based scientific project focusing on mechanism. Other projects can be designed to be multidisciplinary or singular in scientific focus.

Activities conducted under this RFA should be consistent with federal Executive Order No. 12988 ("Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations") when appropriate. To the extent practicable and permitted by law, grantees shall make achieving environmental justice part of their project's mission by identifying and addressing, as appropriate, disproportionately high and adverse human health effects of environmental contaminants on minority, low-income, and medically underserved children.

This RFA will use the NIH program project grant (P01) and the EPA's Science to Achieve Results (STAR) program. It is anticipated that a total of $9 million, including direct and facilities/administrative costs, will be available for the first year of the program, which will support up to six centers in fiscal year 2004. The NIEHS and the EPA may solicit additional new center applications in the future through subsequent issuance of a similar RFA addressing children's environmental health.

The deadline for receipt of letters of intent is 16 April 2003, with 16 May 2003 the deadline for receipt of applications. Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.h tml in an interactive format. Complete information on this announcement is located at http://grants1. nih.gov/grants/guide/rfa-files/RFA-ES-03-004.html.

Contact: Gwen W. Collman, Chemical Exposures and Molecular Biology Branch, Division of Extramural Research and Training, NIEHS, PO Box 12233, EC-21, 111 T. W. Alexander Dr, Research Triangle Park, NC 27709 USA, 919-541-4980, fax: [phone], e-mail: [e-mail]; or Chris Saint, National Center for Environmental Research, U.S. EPA (8723R), 1200 Pennsylvania Ave NW, Washington, DC 20460 USA, 202-564-6909, fax: [phone], e-mail: [e-mail]. Reference: RFA No. ES-03-004

Health Disparities in Rheumatic, Musculoskeletal, and Skin Diseases

The National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Eye Institute, and the NIEHS invite applications for research to promote the design, development, and testing of hypothesis-driven innovative approaches to eliminating health disparities in rheumatic, musculoskeletal, and skin diseases. Attention will focus on potentially modifiable environmental, social, and behavioral factors and on gene-environment interactions that may underlie ethnic/racial disparities in disease prevalence and outcome. In addition, descriptive and analytic epidemiologic studies are needed to characterize further the health disparities in rheumatic, musculoskeletal, and skin diseases. This program announcement (PA) is based on the many scientific opportunities identified in the conference "Health Disparities in Arthritis and Skin Diseases," summarized online at http://www. niams.nih.gov/ne/reports/sci_wrk/2000/hdreg.htm.

Rheumatic, musculoskeletal, and skin diseases are the most frequent chronic health problems in the United States, but not all population groups are equally affected. Marked differences in the incidence, prevalence, severity, process of care, and outcome of a number these conditions exist among racial and ethnic groups. For conditions such as systemic lupus erythematosus (SLE), vitiligo, keloids, and scleroderma, the burden is greatest in particular ethnic groups. Research is needed to increase understanding of these disparities and their causes, and to provide direction for improving standards of care, informing public policy, and identifying strategies aimed at improving the health status and health outcomes of racial and ethnic minorities. Research is needed to enhance our understanding of the underlying factors that influence the health status of racial and ethnic minority populations across the lifespan.

Racial/ethnic disparities in rheumatic, musculoskeletal, and skin diseases have been identified; non-Caucasian populations not only have a higher overall occurrence of SLE, but also seem to have lower survival rates. SLE-related organ damage occurs more frequently in Hispanics than in African Americans or Caucasians. Kidney damage is more prevalent in Hispanics and African Americans compared to Caucasians, and there is increased incidence of organ/tissue damage in Hispanics as compared to both Caucasians and African Americans. Neuropsychiatric problems account for the greatest proportion of damage in Hispanics and Caucasians, whereas hair loss and skin damage account for the greatest proportion in African Americans.

The most important variables influencing early mortality, however, have been found to be socioeconomic and demographic, rather than ethnic/racial or genetic factors. In scleroderma, incidence and prevalence is increased in women of color, with increased disease-related morbidity and mortality. Ethnic disparities in the prevalence, severity, and treatment of osteoarthritis (OA) have been documented as well. African-American women have a higher prevalence of radiographic knee OA than Caucasian women. African-American men of lower socioeconomic status have been found to have more radiographic hip OA and more bilateral hip OA than Caucasian and higher-socioeconomic-status African-American men. African Americans, Hispanics, and Asians appear to be less likely than Caucasians to undergo total joint replacements for OA of the hip. Further study is needed to determine the nature and mechanisms of these disparities, and to ameliorate them.

Much less is known about the frequency and impact of skin diseases in specific racial/ethnic populations. Keloids occur more often in African Americans than among other groups, and anecdotal data suggest atopic dermatitis is more prevalent and more severe in African Americans and Asian/Pacific Islanders. The skin manifestations of lupus, sarcoidosis, and a number of other diseases are more common and more severe in African Americans. Some racial/ethnic disparities in treatment of skin diseases have been identified. Finally, the social and psychological burden of some skin diseases is likely to vary depending on skin pigmentation (e.g., the impact of vitiligo, an acquired skin disease characterized by patches of unpigmented skin, on dark-skinned versus light-skinned individuals), but little research has been directed at elucidating disparities in the burden of disease.

Some of the disparities seen in the treatment and management of these diseases may be explained by differences in availability and quality of health services. Individual beliefs, attitudes, and behavior with regard to health care utilization, self-care practices, and health-related habits may be important factors to consider. Family variables, culture, socioeconomic status, social support, and other factors no doubt influence these individual beliefs, attitudes, and behaviors. Further, these factors may vary systematically across racial/ethnic groups. Finally, common approaches to research design, methodology, and measurement may require adaptation to enhance access to minority and lower-socioeconomic-status populations, and to increase the validity and reliability of research data.

This PA encourages investigator-initiated research projects that explore new approaches and hypotheses for understanding and eliminating health disparities in rheumatic, musculoskeletal, and skin diseases. Areas of interest include 1) epidemiological studies on the nature and source of racial/ethnic differences in the rates and patterns of disease; 2) studies on interaction or additive effects of genetic and environmental factors in health disparities; 3) studies on underlying causes of health disparities for specific diseases of joints, muscle, bone, or skin that disproportionately affect ethnic or minority populations; 4) studies on knowledge, attitudes, behaviors, and social factors relating to differential access to and utilization of health care; 5) development and testing of interventions to decrease disparities in the management of disease; 6) identifying socioeconomic, educational, and behavioral risk factors for increased disability and preventive intervention strategies that target at-risk populations; 7) development and testing of measurement tools and approaches to characterize disease-related health status, health quality of life, or health-related attitudes and beliefs in racial/ethnic and/or low-socioeconomic-status samples; and 8) studies on cultural competence of health care providers and its impact on treatment provision, patient behaviors, and health outcomes.

This PA will use the NIH Research Project Grant (R01) award mechanism. This PA uses Just-In-Time concepts. It also uses the modular as well as the nonmodular budgeting formats (see http://grants.nih.gov/ grants/funding/modular/modular.htm). Specifically, if you are submitting an application with direct costs in each year of $250,000 or less, use the modular format. Otherwise, follow the instructions for nonmodular research grant applications.

Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih. gov/grants/funding/phs398/phs398.html in an interactive format. Applications submitted in response to this PA will be accepted at the standard application deadlines, which are available at http://grants.nih.gov/ grants/dates.htm. Application deadlines are also indicated in the PHS 398 application kit. Complete information on this PA is available at http://grants1.nih. gov/grants/guide/pa-files/PA-03-054.html.

Contact: Deborah Ader, Behavior and Prevention Research Program, NIAMS, One Democracy Pl, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5032, fax: [phone], e-mail: [e-mail]; Richard S. Fisher, Corneal Diseases Program, NEI, Bldg EPS, Ste 350, 3120 Executive Blvd, Rockville, MD 20892 USA, 301-451-2020, fax: [phone], e-mail: [e-mail]; Gayle Lester, Osteoarthritis Initiative and Diagnostic Imaging Program, NIAMS, One Democracy PI, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5055, fax: [phone], e-mail: [e-mail]; Richard Lymn, Muscle Biology Program, NIAMS, One Democracy PI, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5128, fax: [phone], e-mail: [e-mail]; Joan McGowan, Bone Diseases Program, NIAMS, One Democracy Pl, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5055, fax: [phone], e-mail: [e-mail]; Alan N. Moshell, Skin Diseases Program, NIAMS, One Democracy PI, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5017, fax: [phone], e-mail: [e-mail]; James Panagis, Orthopaedics Program, NIAMS, One Democracy Pl, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5055, fax: [phone], e-mail: [e-mail]; Bernadette Tyree, Cartilage and Connective Tissue Program, NIAMS, One Democracy Pl, Ste 800, Bethesda, MD 20892-4872 USA, 301-594-5032, fax: [phone], e-mail: [e-mail]; or Frederick Tyson, Chemical Exposures and Molecular Biology Branch, Division of Extramural Research and Training, NIEHS, MD EC-21, PO Box 12233, Research Triangle Park, NC 27709 USA, 919-541-0176, e-mail: [e-mail]. Reference: PA No. PA-03-054.