Native American Research Centers for Health (NARCH) Grants, 78570-78586 [E8-30300]

Agencies

• DEPARTMENT OF HEALTH AND HUMAN SERVICES
• Indian Health Service

[Federal Register Volume 73, Number 246 (Monday, December 22, 2008)]
[Notices]
[Pages 78570-78586]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-30300]



[[Page 78569]]

-----------------------------------------------------------------------

Part VII





Department of Health and Human Services





-----------------------------------------------------------------------



Indian Health Service



-----------------------------------------------------------------------



Native American Research Centers for Health (NARCH) Grants; Notice

Federal Register / Vol. 73, No. 246 / Monday, December 22, 2008 / 
Notices

[[Page 78570]]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Native American Research Centers for Health (NARCH) Grants

    Announcement Type: New and Competing Continuations.
    Funding Announcement Number: HHS-2010-IHS-NARCHVI-0001.
    Catalog of Federal Domestic Assistance Numbers (s): 93.933.
    Key Dates: Letter of Intent Deadline: March 15, 2009.
    Application Deadline Date: May 14, 2009.
    Review Date: October, 2009.
    Earliest Anticipated Start Date: June 1, 2010.

I. Funding Opportunity Description

    The Indian Health Service (IHS), in conjunction with the National 
Institute of General Medical Sciences (NIGMS) and other institutes of 
the National Institutes of Health (NIH) announces competitive grant 
applications for Native American Research Centers for Health (NARCH), 
an initiative to support new and/or continuing centers or projects 
funded under the NARCH grant program. This funding mechanism will 
develop further opportunities for conducting research and research 
training to meet the needs of American Indian/Alaska Native (AI/AN) 
communities. This program is authorized under the Snyder Act, 25 U.S.C. 
13, the Public Health Service Act, 42 U.S.C. 241 as amended, and the 
Indian Health Care Improvement Act, 25 U.S.C. 1602(a)(b)(16). This 
program is described at 93.933 in the Catalog of Federal Domestic 
Assistance.

Background Information:

    The AI/AN Tribal nations and communities have long experienced 
health status worse than that of other Americans. Although major gains 
in reducing health disparities were made during the last half of the 
twentieth century, most gains stopped by the mid-1980s (Trends in 
Indian Health 1998-99) and a few diseases, e.g., diabetes, worsened. 
''All Indian'' rates contain marked variation among the IHS Areas or 
regions (Regional Differences in Indian Health 1998-99); and variation 
by Tribe exists within Areas as well. The Trends and Regional 
Differences reference can be found at the IHS Web site at: https://
www.ihs.gov/NonMedicalPrograms/IHS_Stats. Although the AI/AN mortality 
rates for all cancers are about 20 percent lower than the U.S. rates 
for all races, there is variation among IHS Areas for specific cancers. 
Moreover, the favorable AI/AN mortality rates for some cancers may be 
due to markedly lower incidence rates partly offset by higher case-
fatality rates. Unfamiliarity with modern health care may adversely 
influence health status among the elderly, the low-income elderly, and 
Tribes, and also may reduce the acceptability of health research among 
them. The daunting tasks confronting Tribes, researchers, and health 
care and public health programs in the beginning of the twenty-first 
century are to resume the reduction of health disparities that had 
occurred through the 1980s, to reverse the worsening in a few diseases, 
to maintain and strengthen the favorable status, and to reduce the 
disparities among and within Areas and Tribes. Factors known to 
contribute to health status and disparities are complex, and include 
underlying biology, physiology, and genetics, as well as ethnicity, 
culture, socioeconomic status, gender/sex, age, geographical access to 
care, and levels of insurance.
    Additional factors known to contribute to health status and 
disparities include:
    1. Family, home, and work environments;
    2. General or culturally specific health practices;
    3. Social support systems;
    4. Lack of access to culturally appropriate health care; and
    5. Attitudes toward health.
    Yet none of these alone, or in combination, accounts for all 
documented differences. Health disparities of AI/ANs may also reflect a 
lack of in-depth research relevant to improving their health status. 
Many AI/ANs distrust research for historical reasons. One approach that 
combats this distrust is to ensure that Tribes are the managing 
partners in training and research that involves them, as for example, 
in community-based participatory research (i.e., a collaborative 
research process between researchers and community representatives). 
This approach is especially helpful to design both training relevant to 
researchers from Tribal communities, and research relevant to the 
health needs of the communities.

Research Objectives:

    The NARCH initiative will support partnerships between Federally 
recognized AI/AN Tribes or Tribal organizations (including national and 
area Indian health boards, and Tribal colleges meeting the definition 
of a Tribal organization as defined by 25 U.S.C. 1603(d) or (e)) and 
institutions that conduct intensive academic-level biomedical, 
behavioral and health services research. These partnerships are called 
Native American Research Centers for Health (NARCH). Due to the 
complexity of factors contributing to the health and disease of AI/ANs, 
and to their health disparities compared with other Americans, the 
collaborative efforts of the agencies of the Department of Health and 
Human Services (HHS) and the collaboration of researchers and AI/AN 
communities are needed to achieve significant improvements in the 
health status of AI/AN people. To accomplish this goal, in addition to 
objectives set by the Tribe, Tribal organization or Indian health 
boards, the IHS NARCH program will pursue the following program 
objectives:
     To develop a cadre of AI/AN scientists and health 
professionals--Opportunities are needed to develop more AI/AN 
scientists and health professionals engaged in research, and to conduct 
biomedical, clinical, behavioral and health services research that is 
responsive to the needs of the AI/AN community and the goals of this 
initiative. Faculty/researchers and students at each proposed NARCH 
will develop investigator-initiated, scientifically meritorious 
research projects, including pilot research projects, and will be 
supported through science education projects designed to increase the 
numbers of, and to improve the research skills of, AI/AN investigators 
and investigators involved with AI/ANs.
     To enhance partnerships and reduce distrust of research by 
AI/AN communities--Recent community-based participatory research 
suggests that AI/AN communities can work collaboratively in partnership 
with health researchers to further the research needs of AI/ANs. Fully 
utilizing all cultural and scientific knowledge, strengths, and 
competencies, such partnerships can lead to better understanding of the 
biological, genetic, behavioral, psychological, cultural, social, and 
economic factors either promoting or hindering improved health status 
of AI/ANs, and generate the development and evaluation of interventions 
to improve their health status. Community distrust of research and 
researchers will be reduced by offering the Tribe greater control over 
the research process.
     To reduce health disparities--In the Indian Health Care 
Improvement Act, Public Law 94-437 (as amended), IHS was legislatively 
mandated to improve the delivery of effective health care to AI/ANs. In 
the NIH Revitalization Act of 1993, NIH was encouraged to increase

[[Page 78571]]

the number of under-represented minorities participating in biomedical, 
clinical, and behavioral research, including studies on drug abuse and 
alcoholism, and the examination of the role of resiliency in the 
prevention and treatment of those conditions. Also, the ``Initiative to 
Eliminate Racial and Ethnic Disparities in Health'' by HHS (https://
www.omhrc.gov/rah) encouraged NIH to help reduce health disparities. In 
response to these priorities, the IHS and NIH have established a 
collaboration to support the NARCH.
    Reducing health disparities among AI/AN communities and individuals 
may be fostered by greater understanding of how to enhance their 
strengths and resilience. While AI/AN communities have relied on health 
research and medical science to reduce health disparities, they have 
also relied on their own psychological, organizational, and cultural 
assets and strengths to survive major harms and disruptions over the 
centuries, and to rebound from insults to health.
    The mission of NIH is to acquire new knowledge that will lead to 
better health by understanding the processes underlying health and 
disease that in turn will help prevent, detect, diagnose, and treat 
disease and disability. The NARCH initiative works toward the NIH 
mission by supporting research that discovers the interrelationships 
among the many factors that contribute to health and disease, and by 
helping to train and promote AI/AN researchers and researchers 
concerned with AI/AN health.

II. Award Information

    Type of Awards: Grant.
    Estimated Funds Available: The estimated funds (total costs) 
available for the first year of support for the entire initiative is 
expected to be at least $2.0 million in Fiscal Year 2010. The actual 
amount may vary, depending on the response to the request for 
applications (RFA) and availability of funds. An applicant may request 
a project period not to exceed four years of support, and direct costs 
not to exceed $1,100,000 per center or $550,000 per project (research 
or training) in the first year of each award. Direct costs to the 
applicant include the total cost of each subcontract (subcontractor 
direct plus subcontractor indirect costs).
    Anticipated Number of Awards: An estimated five to fifteen awards 
will be made under the program.
    Award Amount: $100,000-$1,100,000 per year.

III. Eligibility Information

    The new or existing NARCH must be a working partnership of the 
eligible AI/AN organization and of the research-intensive institution. 
Applicants eligible to receive the NARCH award are Federally recognized 
Tribes and Tribal organizations as defined under the Indian Health Care 
Improvement Act, 25 U.S.C. 1603 (d) or (e), including eligible Indian 
health boards or Tribal colleges applying on behalf of eligible 
Federally recognized Tribes or Tribal organizations. As the grantee, 
the eligible AI/AN organization will define criteria and eligibility 
for participation in all aspects of the partnership, consistent with 
this announcement. A minimum of 30 percent of the grant funds must be 
budgeted in the application to remain with the eligible AI/AN 
organization(s); that is, no more than 70 percent of the application's 
total budget may be contained in subcontract budgets of the non-
eligible subcontracting partner institutions or organizations.
    1. Eligible Applicants--The AI/AN applicant must be one of the 
following:
     A federally recognized AI/AN Tribe, as defined under 25 
U.S.C. 1603(d); or
     A Tribal organization, as defined under 25 U.S.C. 1603(e), 
including Tribal colleges or health boards meeting this definition; or
     A consortium of two or more of those Tribes or Tribal 
organizations. Applicants other than Tribes must provide proof of non-
profit status.
    2. Cost Sharing or Matching--The NARCH program does not require 
matching funds or cost sharing.
    3. The Research-Intensive Partner--The Research-Intensive Partner 
must be an accredited public or private nonprofit university, academic 
medical center, or other institution that has an established record of 
conducting research into the health problems of AI/AN; has demonstrated 
a commitment to enhancing the capability of AI/AN faculty/researchers, 
students, investigators, and communities to engage in biomedical, 
behavioral, clinical and health services research; and has demonstrated 
a commitment to mentoring AI/AN faculty/researchers, students, and 
investigators.
    4. Principal Investigator--The Principal Investigator, the 
individual responsible for the administration (including fiscal 
management) of the overall project, must have his/her primary 
appointment with the AI/AN applicant organization. Special arrangements 
of employment, such as inter-organizational personnel agreements, are 
permissible. The Principal Investigator may be, but is not required to 
be, the NARCH Program Director or a Research Project Investigator. The 
NARCH Principal Investigator may or may not have formal academic/
research credentials, but if not, then the NARCH Program Director must 
be so qualified.
    The traditional NIH research project grant consists of a single 
Principal Investigator (PI) working with a small group of subordinates 
on an independent research project. Although this model clearly 
continues to work well and encourages creativity and productivity, it 
does not always work well for multidisciplinary efforts and 
collaboration. Increasingly, health-related research involves teams 
that vary in terms of size, hierarchy, location of participants, goals, 
disciplines, and structure. There is growing consensus that team 
science would be encouraged if more than one PI could be recognized on 
individual awards. The NIH has adopted a multiple-PI model, as recently 
directed by the Office of Science and Technology Policy. All agencies 
that have research and research-related programs must offer the 
multiple-PI model as an option. Note, it is only an option, not a 
requirement. The traditional NARCH division of roles between PI and 
Project Director will usually address these issues to a satisfactory 
degree. For additional information regarding the new multiple-PI model, 
please click on the following website: https://grants.nih.gov/grants/
multi_pi/index.htm.
    5. NARCH Program Director--The NARCH Program Director is the 
individual responsible for the day-to-day leadership and management of 
the research and training programs within the proposed NARCH. The 
Program Director may be, but is not required to be, the Student and 
Faculty/Researcher Development Director or a Research Project 
Investigator. The NARCH Program Director may or may not have formal 
academic/research credentials, but if not, then the Principal 
Investigator must be so qualified.
    6. Student and Faculty/Researcher Development Director and 
Participant--The NARCH initiative is an institutional developmental 
grant mechanism that places an emphasis on the continual development of 
students and faculty/researchers. If a new Student and/or Faculty/
Researcher Development Program is proposed in the current application, 
then the Principal Investigator of that project is expected to be the 
NARCH Student and Faculty Development Director. In order to be included 
as the Student and Faculty

[[Page 78572]]

Development Director, the prospective director must have a faculty/
researcher appointment at the research-intensive institution (or 
equivalent appointment at the AI/AN organization or other consortium 
partner) and must demonstrate that he/she has the knowledge, skills, 
and capabilities to mentor students and faculty/researchers and to 
generate and direct development and mentoring programs.
    The Student and Faculty Development Director may be the NARCH 
Program Director. Faculty/researchers and students should be supported 
in research education activities that improve their skills and 
abilities to be successful at the next stage of their professional 
development. To be included as a participant for faculty/researcher 
development in the proposed NARCH, the individual must have a faculty/
researcher appointment at the research-intensive institution or 
equivalent appointment at the AI/AN organization or consortium partner.
    7. Research Project Investigators--The NARCH initiative is an 
institutional developmental grant mechanism that places an emphasis on 
continual improvement of the research competitiveness of the research 
investigators. In order to be included as a research project 
investigator in the NARCH, a prospective investigator must have a 
faculty appointment at the research-intensive institution or equivalent 
appointment at the AI/AN organization or other consortium partner, and 
must show that he/she has the need, based on institutional, 
departmental, and professional development plans, to enhance his/her 
research knowledge, skills, and capabilities by engaging in the 
proposed research program and associated activities.
    8. Tribal Approval of the Application--It is the policy of the IHS 
that all research involving AI/AN Tribes be approved by the Tribal 
governments with jurisdiction. Therefore, the following documentation 
is required as part of the application for new or continuing centers or 
additional NARCH projects:
     Tribal Resolution:
    If the applicant is an Indian Tribe or Tribal organization, a 
resolution supporting the project from the Tribal government of all 
Tribes to be served must accompany the application submission. 
Applications by Tribal organizations will not require resolutions if 
the current Tribal resolutions under which they operate would encompass 
the proposed activities. In this instance, a copy of the current 
resolution must accompany the application. The listed Tribes to be 
served by the project in the proposal must match the set of appended 
resolutions. If a resolution from an appropriate representative of each 
Tribe to be served is not submitted prior to October 1, 2009, the 
application will be considered incomplete and will not be considered 
for funding.
    An official signed resolution must be received by October 1, 2009 
by the Division of Grants Operations (DGO), IHS, at the Reyes Building, 
801 Thompson Avenue, TMP 360, Rockville, MD 20852. A grant will not be 
awarded unless the signed resolution is received. Please include the 
funding opportunity number, as a reference to this announcement, if the 
resolutions are submitted as a separate mailing.
    9. Mechanism of Support--Awards under this initiative will be 
administered using the competing institutional grant mechanism of the 
IHS, and will be reviewed using the NIH S06 mechanism.

IV. Application and Submission Information

    1. Address to Request Application Package: NARCH Program Official, 
Reyes Building, 801 Thompson Avenue, Rockville, MD 20852 or by e-mail 
to narch@ihs.gov. Applicants are strongly encouraged to establish 
eligibility of their proposed applications prior to submission. 
Inquiries about eligibility should be addressed to Alan Trachtenberg, 
M.D., M.P.H., at (301) 443-0578 or by e-mail to narch@ihs.gov. The 
application package, including supplemental instructions will be posted 
on the IHS Research Program Web site, at: https://www.ihs.gov/
MedicalPrograms/Research/narch.cfm. Technical assistance will be made 
available for applicants, and first time applicants are urged to take 
advantage of it. To sign up for technical assistance, potential 
applicants should e-mail their contact information to narch@ihs.gov 
with the words ``technical assistance'' in the subject heading and full 
contact information, including email address, listed in the body of the 
e-mail.
    The NIH instructions for the PHS 398 application form are available 
in an interactive format at: https://grants.nih.gov/grants/funding/
phs398/phs398.html. Applicants must use the currently approved version 
of the PHS 398. For further assistance contact GrantsInfo, Telephone 
(301) 435-0714, e-mail: GrantsInfo@nih.gov, Telecommunications for the 
hearing impaired: TTY 301-451-0088.
    Submit a typed and signed original application, including the 
Checklist, and one (1) single-sided photocopy of the entire application 
(including Appendices and supporting documents) in one package to: 
Division of Grants Operations, Indian Health Service, Reyes Building, 
801 Thompson Avenue, TMP 360, Rockville, MD 20852-1627 (zip code is 
unchanged for express/courier services), Telephone: (301) 443-5204.
    ``Native American Research Centers for Health'' and the RFA number 
NOT-GM-09-010 must be typed on line 2 of the face page of the 
application form and the YES box must be marked.
    At the time of submission, applicants must also send four (4) 
additional single-sided photocopied and signed applications, including 
the Checklist, Appendices, and supporting documentation to: Center for 
Scientific Review (CSR), National Institutes of Health, 6701 Rockledge 
Drive, Room 6160--MSC 7892, Bethesda, MD 20892-7720, Bethesda, MD 20817 
(for express or courier service). Telephone: (301) 435-0715. The CSR no 
longer accepts hand delivered applications. E-mail or other electronic 
applications will not be accepted under this announcement.
    Specific supplementary instructions for the PHS 398 application and 
budget preparation for the NARCH program may be obtained from the 
initiative contacts listed under VII. Agency Contacts, and will be 
posted at: https://www.ihs.gov/MedicalPrograms/Research/narch.cfm. They 
will also be sent to any potential applicant who e-mailed their contact 
information to narch@ihs.gov with the words ``technical assistance'' in 
the subject heading.
    There will be no acknowledgment of receipt of the application.
    2. Content and Form of Application Submission:
    A proposed NARCH may include any or all of the following 
components: Student development projects; faculty/researcher 
development projects; research projects (including pilot projects); and 
``core'' administrative facilities.
    The content of the application should explain the components of the 
application, and how they help meet the purposes of the NARCH 
initiative. A description should be provided of the current state of 
the research and research training enterprise at the proposed NARCH and 
its institutional and community partners, including faculty/researcher 
and student profiles.
    A clear statement should be presented of the overall goals, 
specific measurable objectives, and anticipated milestones. These 
elements should be presented in the context of needed improvements in 
the partners' organizational

[[Page 78573]]

infrastructure and environment for research. Documentation should be 
provided to establish that the research-intensive partner is an 
institution with a record of conducting research into the health of AI/
ANs, and that it has a demonstrated commitment to the special 
encouragement of, and assistance to, AI/AN faculty/researchers, 
students, investigators, and communities for enhancing their capacity 
to engage in biomedical, behavioral and health services research. For 
competitive renewals of existing NARCH grants, previous accomplishments 
and progress from the time of the initial NARCH award must be 
described. Documentation about the nature of the partnership itself 
should be included, such as: the process to develop the application and 
proposed NARCH itself, the past and future efforts to increase the 
capacity of the partners to improve their partnership, and efforts to 
contribute to the success of the NARCH. Applicants are encouraged to 
articulate plans for the development of partnerships toward the 
possible planning of a national native health research conference or 
other national research training. The development of additional future 
collaborative research and research training opportunities should also 
be an integral part of each NARCH core proposal. For previously 
existing NARCH centers, a specific and detailed list of accomplishments 
and assessment of the benefits from the previous NARCH grant(s) is 
required.
    A plan for assessment of the benefits of the activities by the 
proposed NARCH on specific, measurable outcomes identified in the 
application should be provided. IHS and NIGMS recognize that Tribes, 
Tribally-based organizations, and research-intensive institutions are 
diverse in their missions, their health and economic status, and their 
cultures. Such an assessment for a new NARCH could include a self-study 
by the proposed NARCH and its partners, which focuses on fact-finding, 
program evaluation, and recommendations for improvement in key areas.
    Strategies for determining the initial and ongoing success of their 
efforts for organizational development should also be presented. It is 
expected that each proposed NARCH will develop its own set of 
strategies that best match its circumstances. Guidance and suggestions 
for program evaluation of a proposed NARCH can be obtained from https://
www.the-aps.org/education/promote/promote.html. For applications that 
are competing renewals of existing NARCH centers, the report and 
evaluation of the progress made under the previous NARCH grant(s) will 
be a key part of the application.
    Applicants are strongly urged to contact NARCH initiative staff at 
an early stage to request the specific supplementary instructions for 
the PHS 398 for the NARCH grants. Supplementary instructions may be 
obtained from the initiative contacts listed under VII. Agency 
Contacts, and will be posted at: https://www.ihs.gov/MedicalPrograms/
Research/narch.cfm. They will also be sent to any potential applicant 
who e-mailed their contact information to narch@ihs.gov with the words 
``technical assistance'' in the subject heading.
    If Student Development Projects are proposed, the NARCH application 
should describe new programs or modifications or additions to existing 
programs of the partners that encourage and facilitate AI/AN students 
to enter, advance, and remain in health research careers. Such projects 
might include, but are not limited to, providing employment as research 
assistants in research projects of research-active mentors with an 
explicit mentoring plan, providing other mentoring with an explicit 
mentoring plan, providing workshops to improve technical or 
communication skills, providing motivating seminars or journal clubs 
highlighting problems of interest to students, providing contact with 
role models, and providing opportunities to travel to present results 
at national scientific meetings. If research mentorships or 
apprenticeships are proposed, the application should clearly document 
the experience, proposed commitment, and quality of the mentors in 
providing guidance and advice to students (including responsible 
conduct of research and research integrity, teaching, and protection of 
human subjects), and in fostering the development of academic and/or 
community-based AI/AN researchers.
    The application should describe how the development plans for the 
students will meet both the individuals' professional development 
goals, and one purpose of the NARCH initiative: To develop a cadre of 
AI/AN scientists and health professionals. The application must have an 
evaluation plan for the new project(s) that indicates the anticipated 
outcomes relative to the current baseline data. For example, one 
outcome might be the improved retention of AI/AN students in science 
majors. The application should indicate the anticipated (quantitative) 
improvement relative to the current retention rate. Accomplishments of 
(and connections with) any previously funded NARCH student development 
projects by the applicant or partners must be described.
    A student in a NARCH Student Development Project must be a full-
time or part-time student officially enrolled in an educational program 
leading to an undergraduate or graduate degree, or in a post-doctoral 
educational program, or (if well justified) in late high school. A 
helpful book about mentoring science students is found at https://
books.nap.edu/catalog/5789.html.
    If Faculty/Researcher Development Projects are proposed, the NARCH 
application should describe the need, proposed activity, and 
anticipated outcomes. Faculty/researcher development projects might 
include, but are not limited to, short-term mentored research 
experiences in the lab of an active NIH-extramurally-funded researcher 
with an explicit mentoring plan, long-term general mentoring under an 
explicit mentoring plan, or attendance at workshops or courses or 
national meetings needed for acquiring specific skills or methodologies 
needed for prospective research. As with student development projects, 
the application should document the experience, proposed commitment, 
and quality of the mentors, teachers, or experience in providing 
guidance and advice to faculty/researchers, and in fostering the 
development of academic and community-based AI/AN research. The 
application must also describe the evaluation plan for the faculty/
researcher development project. The application must clearly describe 
how the development plans for faculty/researchers will meet both the 
individuals' professional development goals, and two purposes of the 
NARCH initiative:
     To develop a cadre of AI/AN scientists and health 
professionals, and
     To enhance the partnership of the proposed NARCH.
    For grantees with previous NARCH funding for faculty/researcher 
development projects, a detailed list of the accomplishments of (and 
connections with) any previously funded NARCH faculty/researcher 
development projects by the applicant or partners must be described.
    NARCH applications may include a maximum of five (5) regular 
Research Projects and a maximum of five (5) Pilot Research Projects. 
Unlike regular research projects, a pilot research project is limited 
in scope and is not expected to have preliminary data. It is also 
limited to a budget of no more than $75,000 direct costs per year for 
four years. The pilot research project is intended for faculty/
researchers without current Federal research support.

[[Page 78574]]

Support for faculty/researchers participating in pilot research 
projects is preparatory to seeking more substantial funding from NIH 
research grant programs (e.g., Academic Research Enhancement Award, K, 
and R01 awards), as well as funding from other agencies and private 
sources. Funds received from the proposed NARCH to support pilot 
research projects may not be used to supplement ongoing research 
projects. A NARCH application need not include both research projects 
and pilot research projects. Applications for only pilot research 
projects or for only research projects may be submitted. Individual 
project investigators may propose either a research project or a pilot 
research project, but not both. For research projects that are 
continuations or modifications or outgrowths of research projects 
(including pilot research projects) under previous NARCH grants, the 
accomplishments of the previous research project(s) should be detailed 
and a logical description given as to how the results of the previous 
work has led to the current proposal.
    Each research project or pilot research project should follow the 
instructions provided in PHS 398 (Revised 11/2007) for preparing 
research grant applications. The professional development goals must 
clearly describe specific objectives and milestones which should 
include, but are not limited to, improving competitiveness in acquiring 
grant support. The applicant should describe how successful completion 
of the proposed research project will improve the research skills and 
will help develop the students and faculty/researchers, thus 
contributing to the overall goals and specific measurable objectives of 
the proposed NARCH.
    Each research project or pilot research project must follow the IHS 
policy concerning Tribal approval, that all research involving AI/AN 
Tribes be approved by the Tribal governments with jurisdiction. That 
is, each grantee must include a resolution of approval from the Tribal 
government(s), or (if applicable) a letter of support signed by the 
Executive Director or CEO of the eligible AI/AN organization, or both 
(if applicable) for projects that involve people or community(ies) of 
an AI/AN Tribe, or an eligible Tribal organization. For NARCH proposals 
from multi-Tribal consortia with projects that involve only one or a 
few of the Tribes of the consortium, some description should be 
provided as to the process through which the particular Tribes were 
chosen to participate.
    Research projects (including pilot research projects) proposed 
under this initiative must be in research areas normally funded by any 
of the NIH or other research agencies in the HHS. Research projects 
addressing health disparities and the health priorities of the AI/AN 
partner are especially encouraged.
    A listing of grants recently funded by NIH may be found at Computer 
Retrieval of Information on Scientific Projects (CRISP), a searchable 
database of Federally-funded biomedical research projects conducted at 
universities, hospitals, and other research institutions. It may be 
accessed at https://report.nih.gov/crisp/crispquery.aspx. The following 
agencies, institutes, offices, and centers have stated particular 
interests in supporting research under the NARCH Program as follows:

National Institute of Dental and Craniofacial Research (NIDCR)

Oral Health Research

    NIDCR is committed to reducing the disproportionate burden of oral 
diseases experienced by AI/ANs. The focus of NIDCR's health disparities 
research is on improving oral health status and quality of life by 
understanding and addressing oral diseases that are prevalent in AI/AN 
communities, specifically caries (including early childhood caries), 
oral and pharyngeal cancer, and periodontal disease. Interdisciplinary 
research teams and the full participation of communities are viewed by 
NIDCR as essential components of any health disparities research.
    Data that document oral disease prevalence are readily available 
for some populations, but not for others. Homogeneity in subgroups of 
populations cannot be assumed. For instance, there are national data 
for Mexican Americans, but not for the numerous other Hispanic 
subgroups. Similarly, data regarding the oral health status of various 
AI/AN Tribes are unavailable. Moreover, available data provide little 
insight into the etiology or determinants of oral disease and oral 
health. The paucity of quality data and conceptual models concerning 
the broad array of potential determinants and risk-factors inhibits 
progress toward preventing disease, and improving oral health status 
and quality of life. The NIDCR invites applications that, in 
preparation for intervention research, explore the complex array of 
social, behavioral, psychological, contextual, environmental, and 
biological factors and their interactions that may contribute to oral 
health disparities within AI/AN communities. Including oral health 
status measures within broader epidemiologic studies is encouraged. 
However, applications that are limited to the assessment of disease 
prevalence and that explore a very limited range of potential 
determinants will be considered non-responsive.
    The NIDCR has particular interest in intervention research that 
will provide clinically meaningful outcomes and essential information 
needed to inform clinical practice, public health policy, health care 
provision, community and/or individual action. Intervention studies 
that are grounded in theory are needed. Both basic and applied 
intervention research applications are invited. Studies may need to 
intervene at multiple levels within communities. The NIDCR encourages 
the use of the strongest research design possible and recognizes that 
not all intervention research is amenable to randomized clinical 
trials. Examples of health disparities intervention research of 
interest to the NIDCR includes but are not limited to:
     Effectiveness studies that tailor/target preventive 
approaches to communities/individuals;
     Research that intervenes in novel ways on macro- or 
intermediate level determinants of oral health status;
     Health services research that explores alternative 
approaches to delivering preventive oral health care;
     Studies that intervene on common risk factors or that take 
a systems approach;
     Studies that explore multifaceted strategies to intervene 
at several levels within society;
     Dissemination and implementation research at multiple 
organizational levels; and
     Research that uses appropriate technology for translation, 
implementation, adoption, adherence, and acceptance of oral disease 
prevention programs in defined populations, clinics, and communities.
    Intervention research should be reasonably applicable to a specific 
AI/AN population. To facilitate adequate enrollment and 
generalizability, intervention studies may need to be conducted at 
multiple sites. Studies may be conducted at a single site only if 
enrollment is adequate and if sufficient numbers of participants are 
available to allow extrapolation of clinically meaningful results to 
the specific AI/AN population of interest.Pilot research projects that 
are designed to lead to larger research projects funded as part of a 
center or as

[[Page 78575]]

free-standing NIH grants may be proposed.
    For additional information about oral health research contact: Ruth 
Nowjack-Raymer, M.P.H., PhD, Director, Health Disparities Research 
Program, National Institute of Dental and Craniofacial Research, 6701 
Democracy Blvd., Room 640, Bethesda, MD 20892-4878, Phone: (301) 594-
5394, Fax: (301) 480-8322, e-mail: nowjackr@mail.nih.gov.

National Institute on Drug Abuse (NIDA)

Neuroscience and Drug Abuse Research:

    AI/ANs demonstrate higher rates of drug abuse, particularly 
methamphetamine, tobacco and alcohol abuse, relative to other racial 
subgroups. According to 2002-2006 National Survey on Drug Use and 
Health (NSDUH) data, AI/AN past year methamphetamine use was 1.4% 
compared to 0.1% for African Americans, 0.6% for Hispanics or Latinos 
and 0.7% for Whites. Prevalence of use is high in both men and women.
    Drug abuse patterns among AI/AN are complex and can vary by factors 
such as Tribe and geographic location. While some datasets are 
available that can provide general epidemiological data regarding use 
and abuse rates in this group, data are needed that better clarify 
where use rates are highest, among which Tribes, age and gender groups 
and the factors that predict drug abuse in these locales and groups. 
These data will assist in developing more targeted interventions and in 
identifying mechanisms related to drug abuse which can then serve as 
focal points for intervention.
    In addition to scarce data on patterns of use, limited data are 
available assessing drug abuse prevention and treatment interventions 
for AI/AN. The matrix model has been proposed in particular to address 
methamphetamine abuse, but few data are available to assess the 
efficacy of this approach with this population. Several preventive 
interventions have been designed particularly for this population and 
results from them indicate their value, but more research is needed to 
clarify why these sometimes don't work in expected ways and whether the 
interventions that are being used but have not been evaluated are 
working to reduce drug use.
    The NIDA is committed to reducing health disparities in drug abuse 
and related health and social consequences among AI/AN. Further, the 
Institute supports methodologies required by the NARCH, expecting that 
studies be developed and implemented using community participatory 
approaches.
    Research topics of interest include but are not limited to:
     Studies that explore a range of behavioral, cultural, 
environmental, and individual factors that contribute to drug abuse;
     Studies that explore the consequences of drug abuse among 
AI/ANs;
     Studies that consider the full context of drug abuse, 
including poverty, family factors, school factors, intergenerational 
trauma, etc.;
     Studies that explore the role of traditional practices and 
spirituality in protecting against drug abuse;
     Studies that explore other factors that protect against 
use in those groups for whom use rates are lower;
     Studies that explore the efficacy and/or effectiveness of 
culturally relevant preventive interventions;
     Studies that explore the efficacy and/or effectiveness of 
culturally relevant treatment interventions;
     Studies that assess factors related to service 
utilization, including use rates and access to services, either in 
reservation or urban settings; and
     Studies that explore the organization, management and 
delivery of interventions.
    For additional information about neuroscience or drug abuse 
research contact: Kathy Etz, PhD, National Institute on Drug Abuse, 
6001 Executive Blvd., Room 5153 MSC 9589, Bethesda, MD 20852, Phone: 
(301) 402-1749, Fax: (301) 480-2543, e-mail: Kathleen.Etz@nih.hhs.gov.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Alcohol Research

    NIAAA is committed to reducing the disproportionately high burden 
of illness associated with alcohol use, abuse, and dependence among AI/
AN people. Alcohol-associated disability-adjusted life years (DALYs) 
remain highest among AI/ANs in comparison to all other U.S. ethnic 
groups. AI/AN people suffer from unacceptably high rates of alcohol 
abuse and dependence, alcohol-related morbidity and mortality, and 
intentional and unintentional injuries associated with alcohol use. 
Nevertheless, AI/AN people are heterogeneous on many dimensions with 
over 562 Federally-recognized Tribal entities. To address alcohol-
related health disparities of AI/AN people, more needs to be known 
about how differences between Tribes, geographic regions, residence on 
reservations, urban or rural areas, as well as more typical demographic 
variables such as age, education, income, and gender influence alcohol 
use and associated health status outcomes. Such information can guide 
the development of more effective and culturally appropriate ways of 
identifying and intervening with those who suffer from alcohol-related 
problems, as well as preventing alcohol problems before they occur. 
Additional research is also needed to understand how to best advance 
the dissemination of research findings on alcohol and health, so that 
AI/AN people can benefit from the latest research discoveries. Finally, 
NIAAA is aware that oftentimes researchers who conduct investigations 
among communities of color are members of these cultural, racial or 
ethnic groups themselves. NIAAA is committed to identifying and 
providing training and mentoring experiences to help AI/AN alcohol 
researchers advance the science of alcohol use and give back to their 
communities.

    The NIAAA is committed to reducing alcohol related health 
disparities and is committed to the NARCH program. Research topics of 
interest to NIAAA include but are not limited to:

--Studies that assess the differing needs of various Tribal groups, 
considering variations in rates of alcohol use, misuse and abstinence.
--Studies that develop new interventions or adapt existing prevention 
and/or treatment interventions that take strengths of the AI/AN culture 
into consideration.
--Studies that investigate the application/adaptation of evidence based 
interventions among AI/AN groups.
--Studies that investigate how traditional spiritual and medical 
treatments can be applied/adapted to improve intervention outcomes 
among AI/AN peoples.
--Studies that explore the effectiveness and/or efficacy of commonly 
used interventions such as screening and brief intervention or referral 
among AI/AN populations.
--Studies that investigate the risk and protective factors associated 
with drinking among women of childbearing age so as to inform 
culturally sensitive, effective FASD prevention.
--Studies that investigate ways to delay onset of youth drinking among 
AI/AN young people.
--Studies that investigate the association between alcohol use and 
suicide among AI/AN people, especially youth. Studies may attempt to 
understand the individual and

[[Page 78576]]

group level variables that contribute to ``epidemics'' of suicide among 
AI/AN youth.
--Studies that explore the consequences of alcohol use and misuse among 
AI/AN peoples; these consequences may include but are not limited to 
other social and health problems (i.e., diabetes, obesity, poor 
nutrition, cancer, liver disease, etc.), interfamilial violence, 
intentional and unintentional injury, and driving under the influence.
--Studies that investigate the acceptance and efficacy of 
pharmacotherapy for alcohol abuse and dependence within integrated 
health counseling approaches.
--Studies that investigate the influence of alcohol use on the spread 
and treatment of Human Immunodeficiency Virus (HIV)/Acquired Immune 
Deficiency Syndrome (AIDS) among AI/AN peoples.

    For additional information contact:
    Judith A. Arroyo, PhD, Minority Health and Health Disparities 
Coordinator, Project Official, Division of Epidemiology and Prevention 
Research, National Institute on Alcohol Abuse and Alcoholism, 5635 
Fishers Lane Room 2079, Bethesda, MD 20892-9304, (for Fed Ex use 
Rockville, MD 20852-1705), Office: 301-402-0717, Fax: 301-443-8614, e-
mail: Judith.Arroyo@nih.hhs.gov.

National Cancer Institute (NCI)

Cancer Health Disparities Research

    The Center to Reduce Cancer Health Disparities (CRCHD) is committed 
to reducing cancer health disparities among AI/ANs. Investigators are 
encouraged to submit research projects addressing every aspect of 
cancer and cancer health disparities research. CRCHD welcomes 
investigations in basic, clinical, translational, and population-based 
research addressing cancer health disparities among AI/AN. The CRCHD is 
central to the NCI's efforts to reduce the unequal burden of cancer in 
our society. As part of these efforts, the Diversity Training Branch, 
CRCHD, has been supporting NARCH projects with cancer relevance since 
2003.
    For additional information contact:
    Dr. Peter Ogunbiyi, Program Director, Diversity Training Branch, 
Center to Reduce Cancer Health Disparities, National Cancer Institute, 
6116 Executive Boulevard, Suite 602, Bethesda, MD 20892-8341 (U.S. 
Postal Service), Phone: 301-496-7344, Fax: 301-435-9225, e-mail: 
po43t@nih.gov.

Health Literacy Research:

    The HHS, in its Healthy People 2010 initiative, defines health 
literacy as, ``the degree to which individuals have the capacity to 
obtain, process, and understand basic health information and services 
needed to make appropriate health decisions.'' (Please see: https://
www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm). Health 
literacy is a complex phenomenon that involves individuals, families, 
communities, and systems. For instance, consumers, patients, 
caregivers, traditional healers, or other laypersons may vary with 
respect to:
     Access (e.g., to audience-appropriate information, media 
or professionals);
     Skills (e.g., to gather and comprehend health information; 
to speak and share personal information about health history and 
symptoms; to act on information by initiating appropriate follow-up 
visits and conveying understanding back to the information source; to 
make decisions about basic healthy behaviors, such as healthy eating 
and exercise; to engage in self-care and chronic disease management);
     Knowledge (e.g., of health and medical vocabulary, 
concepts such as ``risk'', the organization and functioning of 
healthcare systems, cultural beliefs and possible differences in 
traditional and current medical systems about disease causation, 
prevention and treatment);
     Abilities (e.g., sensory, communication, cognitive, or 
physical challenges or limitations);
     Features of health care providers and public health 
systems (e.g., the communication skills of health professionals, 
platforms employed for patient education, built environments, and 
signage);
     Traditional healers and their role, especially in relation 
to the existing medical systems which could lead to different 
understanding in health and disease progression;
     Demographics (e.g., developmental or life stage, cultural, 
linguistic, or educational differences that affect health beliefs, 
knowledge, and communication).
    Too often people with the greatest health burdens have limited 
access to relevant health information. One reason is the complex and 
cumbersome ways in which health information is presented. Health care 
professionals may not communicate effectively with individuals. For 
instance, achieving informed consent for treatment is difficult when 
health care personnel cannot explain biological processes or treatment 
procedures in simplified language and patients cannot interpret health 
information. These situations hamper the effectiveness of health 
professionals' efforts to prevent, diagnose, and treat medical 
conditions, and limit many health care consumers' abilities to make 
important health care decisions. Another reason is due to individuals' 
limited abilities to fully interpret and understand complex health 
terminology and instructions. This could be further exacerbated by 
different belief systems and adoption of methods for prevention and 
treatment. Limited numeracy can also impede the ability to make 
personal decisions related to risk, risk avoidance, and risk reduction. 
For instance, to follow health care instructions, patients need to be 
able to comprehend written and oral prescription instructions, 
directions for self-care, and plans for follow-up tests and 
appointments.
Specific Objectives
    Researchers are strongly encouraged to review the general 
illustrative examples of topics relevant to health literacy provided 
below. Applications should address health promotion, prevention, 
treatment, or management of diseases or health conditions, and/or the 
improvement of health or health care outcomes. The research must 
involve at least one of the following:
     Health literacy, or one of its many components, as a key 
outcome;
     Health literacy as a key explanatory variable for some 
other outcome;
     Methodological or technological improvement to strengthen 
research on health literacy; and/or
     Prevention and/or intervention strategies that focus on 
health-literacy.
    Studies to develop, or evaluate, the readability or utility of 
specific materials that are intended for single uses or single 
audiences are not responsive to this program announcement unless these 
investigations are integral to testing a significant research 
hypothesis related to health literacy.
Approaches
    A wide variety of research approaches are encouraged:
     Basic research that investigates or describes the nature 
of health literacy and the magnitude of health literacy problems;
     Applied research addressing issues pertinent to health 
literacy practices (e.g., systems level interventions) and research-in-
practice (e.g., active

[[Page 78577]]

potential end users participate as supportive research partners);
     Develop theoretical models, refine research constructs, 
improve methods and measurements, and establish causal relationships 
(e.g., between low health literacy and lack of effective health 
promotion);
     Evaluation research that develops and tests the 
effectiveness of interventions, or adapts and tests existing programs 
(including those that are implemented by health care systems and 
systems outside of health care), to reduce low health literacy and its 
adverse consequences;
     Secondary analyses of existing datasets as well as meta-
analytic studies; and
     Multilevel, multidisciplinary, interdisciplinary, and 
transdisciplinary research is encouraged, especially studies that 
incorporate individual, family, community and societal mediators of 
health literacy in childhood and adulthood, or state-of-the-art health 
communication theory and knowledge.
    For additional information about NCI health literacy research 
contact: Sabra F. Woolley, Ph.D., Program Director, Health 
Communication and Informatics Research Branch, National Cancer 
Institute, 6130 Executive Blvd. Room 4084, Bethesda, Maryland 20892-
7365, Phone: 301-435-4589, Fax: 301-480-2087, E-mail: 
Sabra.Woolley@nih.hhs.gov.

Tobacco Control Research

    AI/ANs have been documented to have the highest smoking rate of any 
major racial/ethnic group in the U.S. According to the 2005 National 
Health Interview Survey of adults 18 and over, 32% of AI/AN are current 
smokers, compared with 21.9% of non-Hispanic whites, 21.5% of non-
Hispanic blacks, 13.3% of Asians and 16.2% of Hispanics. Prevalence of 
smoking is high among both men (37.5%) and women (26.8%).\(1)\ A 
similar pattern can be seen among youth, where AI/AN youth have 
substantially higher smoking prevalence (23.1%) than non-Hispanic 
whites (14.9%), Hispanics (9.3%), non-Hispanic blacks (6.5%), and 
Asians (4.3%), according to data from the National Survey on Drug Use 
and Health. These data also show that non-smoking AI/AN youth 
demonstrated higher susceptibility to experimenting with smoking than 
most other racial/ethnic groups.\(2)\
    At the same time, however, tobacco use patterns among the AI/AN 
population are complex and can vary substantially among subgroups of 
this population. Smoking rates among AI/ANs vary widely by region, 
being highest in the northwestern United States, in Canada, and in 
Alaska. Additionally, use of smokeless tobacco is higher among AI/AN 
adults compared with other racial/ethnic groups. Some studies have 
found particularly high rates of smokeless tobacco use (greater than 
50%) among AN populations, including pregnant women, due to the use of 
Iqmik, a traditional form of smokeless tobacco.\(3)\
    Understanding tobacco use among Native American populations is also 
complicated by the fact that tobacco has had a substantial role in 
Native American culture and tradition. Historically, tobacco has been 
used in medicinal and healing rituals and in ceremonial and religious 
practices. It is important to distinguish the traditional, ceremonial 
uses of tobacco, which are limited to specific occasions, from 
addictive use of tobacco products. However, the relationship between 
these different contexts of tobacco use and their impact on behavior 
has not received sufficient scientific study.
    Moreover, limited data are available on the effectiveness of 
tobacco use cessation interventions targeted to AI/ANs. Preliminary 
focus group studies suggest that Native American smokers are more 
likely to have negative attitudes towards pharmacotherapies, such as 
concerns about side effects and lack of trust in conventional 
medicine.\(4)\ Thus, there is a need to develop culturally-appropriate 
interventions targeted to this population.
    The NCI Tobacco Control Research Branch is committed to supporting 
transdisciplinary research aimed at reducing disparities in tobacco use 
and related health outcomes. The NARCH provides a unique mechanism to 
support collaborative research involving researchers from multiple 
disciplines to address a complex scientific and public health 
challenge.
    Sample research areas of interest include but are not limited to 
the following:
     Studies to understand the role of a range of behavioral, 
cultural, and environmental factors that lead to initiation of tobacco 
use among AI/AN populations;
     Development and evaluation of culturally appropriate 
interventions for tobacco use prevention and cessation targeted to AI/
AN populations;
     Studies of how tobacco related attitudes and behaviors in 
youth and adults are influenced by ceremonial tobacco use and other 
cultural factors;
     Studies of tobacco use behavior in relation to different 
products, including dual use of cigarettes and smokeless tobacco;
     Research on the characteristics, use, and health effects 
of traditional tobacco products, such as Iqmik;
     Research to understand disparities in tobacco use within 
AI/AN populations given substantial variations by region and other 
factors; and
     Studies to identify and address barriers to treatment 
among AI/ANs.

References

    1. Tobacco Use Among Adults--United States, 2005. MMWR. October 
27, 2006; 55: 1145-1148.
    2. Racial/Ethnic Differences Among Youths in Cigarette Smoking 
and Susceptibility to Start Smoking--United States, 2002-2004. MMWR. 
December 1, 2006; 55; 1275-1277.
    3. Renner CC, Patten CA, Day GE, Enoch CC, Schroeder DR, Offord 
KP, Hurt RD, Gasheen A, Gill L. Tobacco use during pregnancy among 
Alaska Natives in western Alaska. Alaska Med. 2005;47:12-16.
    4. Burgess D, Fu SS, Joseph AM, Hatsukami DK, Solomon J, van Ryn 
M. Beliefs and experiences regarding smoking cessation among 
American Indians. Nicotine Tob Res. 2007;9 Suppl 1:S19-28.

    For additional information about NCI tobacco research contact: Mark 
Parascandola, PhD, Epidemiologist, Tobacco Control Research Branch, 
National Cancer Institute, 6130 Executive Blvd. MSC 7337, Executive 
Plaza North, Room 4039, Bethesda, MD 20892, Phone: 301-451-4587, Fax: 
301-496-8675, E-mail: paramark@mail.nih.gov.

National Heart, Lung, and Blood Institute (NHLBI)

Cardiovascular and Respiratory Research

    The NHLBI has a strong history of supporting research to document 
and intervene on health disparities among AI/ANs, including the Strong 
Heart Study, Pathways, Genetics of Coronary Artery Disease in Alaska 
Natives (GOCADAN), the Stop Atherosclerosis in Native Diabetics Study 
(SANDS), and Community-Responsive Interventions to Reduce 
Cardiovascular Risk in AI/ANs.
    The Strong Heart Study showed that many AI/AN communities bear a 
heavy burden of cardiovascular disease (CVD) and cardiovascular risk 
factors (e.g., obesity, diabetes) that could be reduced through 
effective interventions on modifiable risk factors. The high burden of 
disease will worsen unless behaviors and lifestyles affecting CVD risk 
can be changed. Prevalence of obesity in AI/AN communities is about 50% 
higher than in the U.S. general population, in which obesity is often 
described as being of epidemic proportions. In some AI/AN communities, 
cigarette smoking,

[[Page 78578]]

sedentary lifestyle, and stress augment the adverse effects of obesity. 
AI/ANs are particularly vulnerable to Type 2 diabetes, a problem 
exacerbated by high rates of obesity. Diabetes prevalence is 3-20 fold 
higher among AI/ANs than in the general U.S. population. It is an 
important cause of coronary heart disease, cardiomyopathy, end-stage 
renal disease, non-traumatic amputation, and vision impairment. Lipid 
abnormalities also are common in Type 2 diabetics, particularly high 
triglycerides and low HDL-cholesterol levels. Dyslipidemia and blood 
pressure can be improved by appropriate changes in diet and by 
increased exercise. CVD risk is also substantially improved by smoking 
cessation. In addition, attention to high stress levels, untreated 
sleep disordered breathing, short sleep duration, and depression may be 
warranted, because of evidence that they may influence the health 
behaviors of interest. For example, poorer diet, higher smoking rates, 
and physical inactivity are more prominent in those with high stress, 
sleep disorders, or depression. These psychosocial factors also are 
associated with CVD progression in observational epidemiologic studies, 
and there is evidence from smaller clinical studies that they may 
affect mechanisms leading to CVD. NHLBI is interested in supporting 
research in AI/AN communities that promotes the adoption of healthy 
lifestyles and/or improves behaviors related to cardiovascular risk, 
such as weight reduction, regular physical activity, and smoking 
cessation. These behaviors and lifestyles are known to affect 
biological cardiovascular risk factors, such as hypertension, 
dyslipidemia, obesity, glucose intolerance, and diabetes. In addition, 
control of these risk factors by guideline-based use of 
antihypertensive, lipid lowering, and hypoglycemic drugs can reduce 
their adverse consequences. However, these pharmacological 
interventions are often suboptimally utilized in AI/AN communities. The 
NHLBI is interested in reducing cardiovascular disease mortality and 
morbidity in AI/AN, whether by lifestyle changes, drug interventions, 
or combinations thereof.
    Lifestyles characterized by sleeping less than 7 hours per night 
are associated with increased risk of CVD, obesity, diabetes, and all-
cause mortality. Insufficient sleep and poor sleep quality is 
associated with abnormalities in hypothalamic-pituitary axis function 
and behavioral stress. Sleep deprivation compromises vigilance, 
judgment, mood, emotional expression, and other aspects of cognition 
increasing the risk of unstable patterns of behavior. The ability of 
sleep deprivation to enhance the encoding and recall of emotional 
(relative to neutral) memories may profoundly influence social 
interactions and stress. Insufficient sleep is associated with an 
increased risk of new onset substance abuse and relapse, and new onset 
depression and relapse. Intervention studies to assess the efficacy of 
improving sleep as part of a healthy lifestyle or assessing how 
improving sleep disorders could improve CVD outcomes would be of 
interest to NHLBI. Sleep disordered breathing appears to be 30-60% more 
common among American Indians than other racial and ethnic groups. 
Sudden infant death syndrome occurs 2.5 times more frequently in AI/AN 
children than in white children, and 2.0 times more frequently than in 
the U.S. population as a whole.
    AI/AN also have been documented to exhibit high rates of chronic 
respiratory disease. AI/AN adults have the highest asthma rate among 
single-race groups. Recent evidence suggests that 11.6 percent of AI/AN 
suffer from asthma. This is significantly higher than the national 
average of 7.5 percent, and much higher than every other single racial 
or ethnic group. Chronic obstructive pulmonary disease (COPD), which 
includes emphysema and chronic bronchitis, is the sixth leading cause 
of death from chronic disease for AI/AN men and the seventh leading 
cause of death for women. AI/AN have the second highest rates of cystic 
fibrosis following whites. One in 10,500 AI/AN has cystic fibrosis 
compared with one in 3,200 whites. Pueblo Indians and Zuni Indians have 
higher incidence than among other AI/AN Tribes. NHLBI is interested in 
supporting research in AI/AN communities that includes studies of 
approaches to improve clinical delivery of efficacious treatments of 
chronic lung disease and their risk factors, improved methods of 
chronic lung disease self-management, studies to promote or maintain 
respiratory health or improved methods of rehabilitation for diseases 
of the lungs and airways, such as asthma, COPD, cystic fibrosis; sleep 
disordered breathing, occupational lung diseases, pulmonary vascular 
disease or pulmonary complications of AIDS.
    In addition to these areas of research, the NHLBI recognizes a 
unique and compelling need to promote diversity in the biomedical, 
behavioral, clinical, and social sciences research workforce. The NHLBI 
expects eff