[Federal Register Volume 59, Number 133 (Wednesday, July 13, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-16961]


[[Page Unknown]]

[Federal Register: July 13, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[CDC-435]

 

Announcement of Cooperative Agreement to the State of North 
Carolina Department of Environment, Health, and Natural Resources

Summary: The Centers for Disease Control and Prevention (CDC) announces 
the availability of fiscal year (FY) 1994 funds for a cooperative 
agreement program for Diabetes Intervention: Reaching and Educating 
Communities Together (Project DIRECT) with the State of North Carolina 
Department of Environment, Health, and Natural Resources (DEHNR) to 
further develop and carryout multi-level, community-based interventions 
to reduce the burden of diabetes and its complications in an African-
American community.
    Project DIRECT is a multiyear demonstration project of the Division 
of Diabetes Translation (DDT), National Center for Chronic Disease 
Prevention and Health Promotion (NCCDPHP), CDC, incorporating the 
principal translation functions of the division of: (1) Defining the 
burden of diabetes, (2) developing innovative approaches to the 
prevention and control of diabetes, (3) implementing these approaches 
through the State-based diabetes control programs, and (4) coordinating 
national, State, and local resources for improved diabetes care.
    Approximately $650,000 is available in FY 1994 to fund this 
program. This funding is to support administrative start-up costs, to 
include staffing and awarding competitive subcontracts with community 
institutions and organizations conducting specific work related to the 
execution of the intervention plan. Operational funding for 
intervention and evaluation is expected to increase in years 02 through 
05.
    It is expected that the award will begin on or about September 30, 
1994, and will be made for a 12-month budget period within a project 
period of up to 5 years. This funding estimate may vary and is subject 
to change.
    The purpose of Project DIRECT is to: (1) Improve the health-related 
quality of life of an African-American community by reducing the burden 
of diabetes and its complications through a multilevel, community-based 
intervention(s), and (2) develop, carry out, and evaluate strategies 
that will be incorporated into State-based diabetes control programs 
nationwide. The research design of the project is to conduct a baseline 
population survey of a predominantly urban and suburban African-
American community, implement targeted interventions for at least 5 
years, monitor a longitudinal cohort of persons with diabetes, and 
conduct a follow-up survey at the end of the intervention phase to 
detect and document community level changes. There will also be a 
comparison community that will be surveyed at baseline and at follow-
up. This multilevel community intervention will be conducted by a 
consortium of public and private agencies and organizations with 
management and leadership provided by the official State health 
department.
    The CDC will assist in the design of interventions and evaluation 
protocols used in conducting and evaluating the project, provide 
technical assistance in the design of demonstration protocols, provide 
programmatic consultation and guidance in support of the project, 
coordinate with DEHNR in sharing and distributing information, data, 
and successful strategies and interventions to States and other 
appropriate organizations, agencies, and institutions. CDC will also 
provide DIRECT Intervention Plan guidelines and assist in the 
development of a plan for Diabetes Care, Outreach, and Health Promotion 
interventions.
    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 to reduce morbidity and mortality 
and improve the quality of life. This announcement is related to the 
priority area of Diabetes and Chronic Disabling Conditions, with 
particular attention to populations at disproportionate risk of 
developing diabetes, including minorities and the elderly. (For 
ordering a copy of ``Healthy People 2000,'' see the section WHERE TO 
OBTAIN ADDITIONAL INFORMATION.)

    Authority: This program is authorized under Section 301(a) and 
317(k), 42 U.S.C. 241(a) and 247b, of the Public Health Service Act, 
as amended.

Smoke-Free Workplace: The Public Health Service strongly encourages all 
grant recipients to provide a smoke-free workplace and promote the non-
use of all tobacco products. This is consistent with the PHS mission to 
protect and advance the physical and mental health of the American 
people.

Eligible Applicant: Assistance will be provided only to DEHNR for this 
project. No other applications are solicited. The Program Announcement 
and application kit have been sent to DEHNR.
    DEHNR and North Carolina are uniquely situated to conduct this 
project for the following reasons:
    A. In 1990, following an open competition, a contract for the pilot 
phase of Project DIRECT was awarded to a research institution in North 
Carolina. Developmental activities associated with Project DIRECT have 
been conducted in Wake County, North Carolina. Considerable community 
organization and development have occurred to ensure community support 
and involvement in Project DIRECT. A community advisory board of over 
30 local representatives have been actively involved in the project 
since March 1992. Regular coverage through all media channels that 
serve this community has occurred and widespread name recognition of 
the project has been achieved in this community.
    B. A survey of over 900 randomly sampled households in Wake County, 
North Carolina, is complete, and over 250 extensive medical 
examinations were performed on a subsample of the household 
respondents. Response rates exceeded 80%, indicating that expanded 
survey work is feasible in this community. There is no other community 
in the United States for which this type of data exists. Replication of 
work completed to date in another community could only be achieved at 
considerable cost to the government.
    C. The data gathered through the household and medical 
examinations, along with information from a community resource analysis 
for Wake County, provides the database from which a comprehensive, 
multilevel community intervention plan has been developed. The 
intervention strategies match closely with the health care and 
educational needs of this community and the resources available to 
support the interventions in Wake County.
    D. CDC's traditional constituency is State health departments, and 
the intervention components of Project DIRECT are intended to serve as 
model programs for eventual implementation by other official State 
health departments. This cooperative agreement with DEHNR allows CDC to 
evaluate the effectiveness of Project DIRECT in a State health 
department, and to identify the additional liaisons that will be 
required to ensure the viability of diabetes control programs in State 
health departments in a reformed health system. DEHNR has expertise, 
administrative and technical capacity, and public health orientation 
represented in State health departments nationally.
    E. DEHNR has collaborated successfully with universities and 
research institutions in the State. These are important liaisons for 
the successful implementation of Project DIRECT. DEHNR presently has 
established contractual relationships with these academic institutions:
     East Carolina University to develop and teach an 
introductory course in the etiology and management of diabetes 
mellitus.
     The Cancer Control Program at Duke University.
     The Department of Nutrition at the University of North 
Carolina-School of Public Health.
     The Department of Ophthalmology at the University of North 
Carolina-School of Medicine to implement the eye care objectives for 
Diabetes 2000.
    F. DEHNR has an Office of Minority Health that can provide policy 
and programmatic technical assistance to Project DIRECT.
    G. DEHNR participated as a member of the DIRECT Community Advisory 
Board during the pilot phase of the project and they are familiar with 
the philosophy and design of this complex community intervention.

Executive Order 12372 Review

    This application is subject to Intergovernmental Review of Federal 
Programs as governed by Executive Order (E.O.) 12372. E.O. 12372 sets 
up a system for State and local government review of proposed Federal 
assistance applications. The applicant should contact their State 
Single Point of Contact (SPOC) as early as possible to alert them to 
the prospective application and receive any necessary instructions on 
the State process. A current list of SPOCs is included in the 
application kit. If the SPOC has any State process recommendations on 
the application submitted to CDC, they should send them to Elizabeth M. 
Taylor, Grants Management Officer, Grants Management Branch, 
Procurement and Grants Office, Centers for Disease Control and 
Prevention (CDC), 255 East Paces Ferry Road, NE., Atlanta, GA 30305, no 
later than 60 days after the application deadline. The granting agency 
does not guarantee to ``accommodate or explain'' State process 
recommendations it receives after that date.

Public Health System Reporting Requirement

    This program is not subject to the Public Health System Reporting 
Requirements.

Catalog of Federal Domestic Assistance Number

    The Catalog of Federal Domestic Assistance Number is 93.283.

Other Requirements:

Paperwork Reduction Act

    Projects that involve the collection of information from 10 or more 
individuals and funded by this cooperative agreement will be subject to 
review by the Office of Management and Budget (OMB) under the Paperwork 
Reduction Act.

Human Subjects

    If the proposed project involves research on human subjects, the 
applicant must comply with the Department of Health and Human Services 
Regulations, 45 CFR Part 46, regarding the protection of human 
subjects. Assurance must be provided to demonstrate that the project 
will be subject to initial and continuing review by an appropriate 
institutional review committee. The applicant will be responsible for 
providing assurance in accordance with the appropriate guidelines and 
form provided in the application kit.

Where to Obtain Additional Information:  If you are interested in 
obtaining additional information regarding this project, please refer 
to Announcement 435 and contact Bernice A. Moore, Grants Management 
Specialist, Grants Management Branch, Procurement and Grants Office, 
Centers for Disease Control and Prevention (CDC), 255 East Paces Ferry 
Road, NE., Room 305, Mailstop E-16, Atlanta, GA 30305, telephone (404) 
842-6802.
    A copy of ``Healthy People 2000'' (Full Report, Stock No. 017-001-
00474-0) or ``Healthy People 2000'' (Summary Report, Stock No. 017-001-
00473-1) referenced in the Summary may be obtained through the 
Superintendent of Documents, Government Printing Office, Washington, DC 
20402-9325, telephone (202) 783-3238.

    Dated: July 7, 1994.
Martha Katz,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).
[FR Doc. 94-16961 Filed 7-12-94; 8:45 am]
BILLING CODE 4163-18-P