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



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Part VII





Department of Health and Human Services





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Indian Health Service



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

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

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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: http://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

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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 (http://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: http://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

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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 [email protected]. 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 [email protected]. The 
application package, including supplemental instructions will be posted 
on the IHS Research Program Web site, at: http://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 [email protected] 
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: http://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: [email protected], 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: http://www.ihs.gov/MedicalPrograms/Research/narch.cfm. They 
will also be sent to any potential applicant who e-mailed their contact 
information to [email protected] 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

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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 http://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: http://www.ihs.gov/MedicalPrograms/Research/narch.cfm. They will also be sent to any potential applicant 
who e-mailed their contact information to [email protected] 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 http://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.

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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 http://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: [email protected].

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: [email protected].

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: [email protected].

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: 
[email protected].

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: http://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: 
[email protected].

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: [email protected].

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 efforts to diversify the workforce to lead to:
     The recruitment of the most talented researchers from all 
groups;
     An improvement in the quality of the educational and 
training environment;
     A more balanced perspective in the determination of 
research priorities;
     An improved capacity to recruit subjects from diverse 
backgrounds into clinical research protocols; and
     An improved capacity to address and eliminate health 
disparities.
    For more information, please contact: Jared B. Jobe, Ph.D. 
(Cherokee), Program Director, Clinical Applications and Prevention 
Branch, Division of Prevention and Population Sciences, National Heart, 
Lung, and Blood Institute, 6701 Rockledge Drive, Suite 10018, MSC 7936, 
Bethesda, Maryland 20892-7936 (20817 express), Phone: (301) 435-0407, 
Fax: (301) 480-5158, E-mail: [email protected].

National Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS)

Research in Osteoporosis and other Bone Diseases, Osteoarthritis, 
Rheumatoid Arthritis and Skin Disease Within the NIAMS Mission

    The NIAMS supports efforts to conduct research into the causes, 
treatment, and prevention of arthritis and musculoskeletal and skin 
diseases; the training of basic and clinical scientists to carry out 
this research; and the dissemination of research progress to improve 
the public health. Goals specific to the AI/AN communities involve 
research addressing the training of underrepresented minority AI/AN 
researchers and ensuring inclusion of Native communities in clinical 
research studies. NIAMS actively monitors the inclusion of minority 
populations in clinical research and will highlight any grants that 
specifically target AI/AN populations. The mission of the NIAMS is to 
support research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training of basic 
and clinical scientists to carry out this research, and the 
dissemination of information on research progress in these diseases. 
Studies in these mission areas as they relate to the AI/AN population 
may be proposed.
    For additional information about research in these areas contact: 
Dr. Phil Tonkins, National Institute of Arthritis and Musculoskeletal 
and Skin Diseases, 6701 Democracy Blvd., Suite 800, Bethesda, MD 20912, 
Phone: (301) 594-4979, Fax: (301) 480-1284, E-mail: 
[email protected].

[[Page 78579]]

National Center for Complementary and Alternative Medicine (NCCAM)

Research on Traditional Healing Practices

    Many AI/AN communities use traditional healing practices to prevent 
and/or treat diseases and to maintain health. NCCAM is interested in 
supporting research on traditional healing practices with these goals 
in mind. NCCAM is also interested in research on the safe and effective 
integration of conventional care with traditional healing practices for 
AI/AN communities. The methodological feasibility for integration has 
yet to be addressed for many traditional healing practices. 
Consequently, NCCAM is interested in supporting developmental studies 
to identify and address difficult methodological and design issues 
particular to traditional healing practices, as well as to allow for 
the development of contextually and culturally sensitive research 
mirroring the values of AI/AN communities.
    Examples of study areas of interest include, but are not limited 
to:
     Qualitative research to characterize and document healing 
practices and diagnostic approaches of indigenous peoples, and study 
the feasibility of research on those practices and approaches in future 
clinical studies;
     Observational studies to explore patient and care provider 
preferences, beliefs, attitudes, and patient-provider interactions;
     Case-control, observational, and other studies to 
understand traditional healing strategies from multiples perspectives, 
including: (a) Optimal dosing, duration, and frequency of treatment; 
(b) type of treatment; (c) examinations of different healing practices 
to treat a particular disease/condition; (d) comparisons of complex 
versus simple interventions; (e) evaluation of adherence among patient 
populations to interventions with varying levels of complexity; and (f) 
examination of potentially important individual differences that 
mediate or moderate treatment outcome;
     Studies to determine if traditional healing practices can 
be translated into a broader clinical setting, in terms of: 
Reliability, responsiveness and utility; assessment procedures, 
instruments, and tools in psychosocial, functional, and physiological 
domains;
     Studies to construct and validate culturally sensitive 
data collection instruments; to design and pilot outcome measures 
consistent with the tenets of traditional, indigenous systems of 
medicine and comparisons of these outcome measures to those commonly 
used by conventional biomedicine; and
     Health services research of established AI/AN traditional 
healing practices to explore the factors that influence access to and 
use of such therapies; the nature, cost effectiveness, and quality of 
such care; and ultimately the effects on health and well-being.
    For additional information on NCCAM-supported research topics, 
contact:
    Sheila A. Caldwell, Ph.D., Program Officer, Office of Special 
Populations, National Center for Complementary and Alternative 
Medicine, 6707 Democracy Boulevard, Suite 401, MSC 5475, Bethesda MD, 
20892-5475, Phone: (301) 594-3396, Fax: (301) 480-3621, E-mail: 
[email protected].

Office of Research on Women's Health (ORWH)

Women's Health Research

    The ORWH at the NIH supports research related to women's health and 
the study of sex and gender differences. Detailed information about the 
NIH Research Priorities for Women's Health, can be found at http://orwh.od.nih.gov/research.html.
    For additional information on women's health research, contact: 
Lisa Begg, Dr. P.H., R.N., Director of Research Programs, NIH Office of 
Research on Women's Health, 6707 Democracy Blvd., Suite 400, Bethesda, 
MD 20892-5484, Phone: (301) 496-7853, Fax: (301) 402-1798, E-mail: 
[email protected].

National Insitute of Mental Health (NIMH)

Research projects aimed at understanding the burden, treatment, 
intervention or prevention of mental disorders and Human 
Immunodeficiency Virus (HIV)/AIDS in AI/AN populations

    Indigenous people in the United States are disproportionately 
affected by mental illness and HIV infection, as are the larger racial 
and ethnic populations such as African Americans and Latinos. AI/ANs 
are highly underrepresented in the physician workforce, as researchers, 
and in health research in general, numbering fewer than one hundred. 
Other factors that contribute to disparities that affect these 
communities include geographic isolation, poor access to health 
services, underutilization of health services, insufficient screening 
and partner management services, social and cultural norms, 
linguistics, stigma, and gender. Research is needed to identify and 
address the impact as well as the specific and unique aspects of mental 
disorders and HIV infection upon Native American communities. A 
critical component of response to mental health and HIV infection in 
Native American communities will be to identify, train, mentor, and 
develop Native American investigators. Towards these ends, a promising 
model is community-based participatory research together with community 
capacity building.
    Areas of interest to the NIMH that can contribute to scientific 
knowledge about mental health and HIV interventions in Native Americans 
include, but are not limited to research studies:
     To investigate the clinical epidemiology of mental 
disorders and HIV infection across all clinical and service settings 
(e.g., primary care);
     To investigate research methods/community assessment to 
eliminate mental health disparities;
     To evaluate the impact of traumatic stress and other 
social, cultural, interpersonal, and environmental factors on risk for 
and course of mental disorders;
     To examine patient, provider, and contextual factors that 
influence diagnosis, help-seeking decisions and preferences, and the 
helping relationship;
     To understand processes underlying HIV and mental illness 
stigmas and discrimination in Native American communities;
     To develop and assess effective strategies and approaches 
for reducing HIV and mental illness stigmas and discrimination;
     To evaluate the effectiveness of treatment, pharmacologic, 
psychosocial (psychotherapeutic and behavioral), somatic, 
rehabilitative, and combination interventions on mental and behavior 
disorders--including acute and longer-term therapeutic effects on 
functioning for children, adolescents, and adults;
     To develop and tailor/target interventions to communities/
individuals of Native Americans;
     To employ interventions that improve quality and outcomes 
of care (including diagnostic, treatment, preventive, and 
rehabilitation services);
     To conduct scientifically rigorous investigations of 
culturally appropriate interventions, prevention, and control 
strategies;
     To employ services interventions that remove barriers to 
care leading to the elimination of mental health disparities;
     To conduct studies of services organization, delivery 
(process and receipt of care), and related health economics at the 
individual, clinical,

[[Page 78580]]

program, community, and systems levels in specialty mental health, 
general health, and other delivery settings (such as the workplace, 
schools);
     To enhance research infrastructure and build research 
capacity for conducting intervention and services research;
     To explore alternative approaches (e.g., telehealth) to 
translating, delivering, implementing, and disseminating mental health 
care;
     To investigate adaptation, evaluation, safety, and costs 
of proven interventions;
     To explore dissemination and implementation strategies at 
multiple organizational levels; and
     To examine the role of community stakeholders in the 
research process, especially readiness for change.
    For additional information on NIMH NonAIDS Applications contact: 
Carmen P. Moten, Ph.D., Chief, Primary Care, Socio Cultural and 
Disparities Research Programs, Division of Services and Intervention 
Research, National Institute of Mental Health, 6001 Executive 
Boulevard, Room 7131, MSC 9631, Bethesda, MD 20892-9631, Phone: (301) 
443-3725, Fax: (301) 443-4045, E-mail: [email protected].
    For additional information on NIMH HIV/AIDS-related applications 
contact: David M. Stoff, Ph.D., Chief, HIV/AIDS Neuropsychiatry 
Program, AIDS Research Training and HIV/AIDS Disparities Program, 
Division of AIDS and Health and Behavior Research, National Institute 
of Mental Health, 6001 Executive Boulevard, Room 6210, MSC 9619, 
Bethesda, MD 20892-9619, Phone: (301) 443-4625, Fax: (301) 443-9719, E-
mail: [email protected].
    For additional information on NIMH research on Stigma and Health 
Disparities contact: Emeline Otey, Ph.D., Chief, Stigma and Health 
Disparities Program, Division of AIDS and Health and Behavior Research, 
National Institute of Mental Health, 6001 Executive Boulevard, Room 
6227, MSC 9615, Bethesda, MD 20892-9615, Phone: (301) 443-9284, Fax: 
(301) 480-2920, E-mail: [email protected].

National Institute of Biomedical Imaging and Bioengineering (NIBIB)

Research in Technology for Health

    The National Institute of Biomedical Imaging and Bioengineering 
(NIBIB) is committed to reducing health disparities through the 
development of new and affordable biomedical technologies. To this end, 
the NIBIB is interested in supporting the translation of biomedical 
technologies that target the health needs of AI/AN communities. 
Specifically, the NIBIB is interested in supporting the development of 
technologies that have broad therapeutic and interventional 
applications as well as technologies that complement technology 
development in all program areas of the NIBIB, http://www.nibib.nih.gov/Research/ProgramAreas.
    For additional information about NIBIB programs contact: John W. 
Haller, Ph.D., National Institute of Biomedical Imaging and 
Bioengineering, NIH/DHHS, 6707 Democracy Blvd., Suite 200, Bethesda, MD 
20892-5649, Phone: (301) 451.4780, Fax: (301) 480.1614, E-mail: 
[email protected].

National Eye Institute (NEI)

Vision Research

    The NEI supports research and health information dissemination with 
the goal of protecting and prolonging the vision of the American 
people. Examples of such activity that may be of interest include, but 
are not limited to:
     Epidemiological studies to determine the prevalence and 
possible risk factors of eye diseases and disorders among AI/AN 
populations;
     Basic research studies into the causes and mechanisms of 
eye diseases and visual impairments in AI/AN, research into disparities 
in access to ophthalmic/optometric health services; and,
     Development and evaluation of culturally appropriate 
health education and intervention.
    For additional information on vision research topics contact: 
Jerome R. Wujek, Ph.D., National Eye Institute, 2020 Vision Place, 
Bethesda, MD 20892-3655, Phone: (301) 451-2020, Fax: (301) 402-0528, E-
mail: [email protected].
    THE OMISSION ABOVE OF ANY NIH INSTITUTE, CENTER, OFFICE, OR 
RESEARCH AREA SHOULD NOT BE TAKEN AS A LACK OF AVAILABILITY OF SUPPORT 
FOR PROJECTS IN THOSE AREAS. NARCH is an NIH-wide partnership, led at 
NIH by the National Institute of General Medical Sciences (NIGMS). 
General research priorities for all of the individual NIH Institutes, 
Centers, Divisions and Offices can be found on their respective Web 
sites at: http://www.nih.gov/icd/index.html. However, applicants and 
potential academic partners are reminded that the NARCH program is 
focused on the research needs of the tribes and not those of the 
federal or academic partners.
    Previous NARCH grants have been funded by the following partners:
     National Institute of General Medical Sciences (NIGMS);
     National Cancer Institute (NCI);
     National Heart, Lung, and Blood Institute (NHLBI);
     National Human Genome Research Institute (NHGR);
     National Institute on Alcohol Abuse and Alcoholism 
(NIAAA);
     National Institute of Allergy and Infectious Diseases 
(NIAID);
     National Institute of Arthritis and Musculoskeletal and 
Skin Diseases (NIAMS);
     National Institute of Dental and Craniofacial Research 
(NIDCR);
     National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK);
     National Institute on Drug Abuse (NIDA);
     National Center for Complementary and Alternative Medicine 
(NCCAM);
     National Center on Minority Health and Health Disparities 
(NCMHD);
     NIH Office of Behavioral and Social Sciences Research 
(OBSSR);
     NIH Office of Research on Women's Health (ORWH); and
     Agency for Healthcare Research and Quality (AHRQ).
    In addition to these partners within HHS, the Federal Collaborative 
on Health Disparities Research (FCHDR), Headquartered in the HHS Office 
of Minority Health (OMH) is in the process of seeking co-funding 
partnerships for the NARCH program with other departments and agencies 
of the Federal Government. Any additional information that develops 
after the publication of this announcement will be posted on the NARCH 
program Web site at http://www.ihs.gov/MedicalPrograms/Research/narch.cfm and disseminated to the TECHASSISTANCE-NARCH listserve 
developed from persons e-mailing their contact information to 
[email protected].
    Public Policy Requirements: All Federal-wide public policies apply 
to IHS grants with exception of the Lobbying and Discrimination public 
policy.
3. Submission Dates and Times
A. Letter of Intent Deadline: March 15, 2009
    Prospective applicants are asked to submit a letter of intent that 
includes the title of the new project(s) proposed, the name, address, 
and telephone number of the project Principal Investigator(s), the 
identities of the partners and of key personnel, and the number and 
title of this RFA. The letter of intent should be received before 5 
p.m. Eastern Standard Time on March 15, 2009, by Mushtaq A. Khan, 
D.V.M.,

[[Page 78581]]

Ph.D., Chief, Digestive and Respiratory Sciences IRGs, Center for 
Scientific Review, MSC 7818, Room 2176; 6701 Rockledge Drive; Bethesda, 
MD 20892 (20817 for express or courier service). Phone: (301) 435-1778; 
Fax (301) 451-2043; E-Mail: [email protected].
    Letters may be submitted by mail, fax or e-mail. Although a letter 
of intent is not required, is not binding, and does not enter into the 
review of a subsequent application, the information that it contains 
allows the IHS and NIH Center for Scientific Review (CSR) staffs to 
estimate the potential review workload and avoid conflict of interest 
in the review.
B. Application Deadline: May 14, 2009
    The applications must be received before 5 p.m. Eastern Standard 
Time on May 14, 2009, at the 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). Phone: (301) 435-0715) and at the IHS Division of 
Grants Operations (DGO) Indian Health Service, Reyes Building, 801 
Thompson Avenue, TMP Suite 360, Rockville, MD 20852-1627 [zip code is 
unchanged for express/courier services], Phone: (301) 443-5204. 
Applications received after this date will be returned to the 
applicant. Competing applications not meeting the deadline date 
specified in the announcement are considered late applications and will 
not be considered for funding under this announcement. The CSR will not 
accept any application in response to this RFA that is essentially the 
same as one currently pending initial review, unless the applicant 
withdraws the pending application.
    The CSR will not accept any application that is essentially the 
same as one already reviewed. This does not preclude the submission of 
substantial revisions of applications already reviewed, but such 
applications must include an introductory letter addressing the 
previous critique.

4. Intergovernmental Review

    This funding opportunity is not subject to Executive Order 12372, 
``Intergovernmental Review of Federal Programs.'' A State approval is 
not required.

5. Funding Restrictions

     Pre-award costs are allowable pending prior approval from 
the awarding agency. However, in accordance with 45 CFR part 74 all 
pre-award costs are incurred at the recipient's risk. The awarding 
office is under no obligation to reimburse such costs if for any reason 
the applicant does not receive an award or if the award to the 
recipient is less than anticipated.
     The available funds are inclusive of direct and 
appropriate indirect costs.
     Only one grant/cooperative agreement will be awarded per 
applicant under this announcement.
     IHS will not acknowledge receipt of applications.
     Grantees are allowed a reasonable period of time in which 
to submit required financial and performance reports. Failure to submit 
required reports within the time allowed may result in suspension or 
termination of an active grant, withholding of additional awards for 
the project, or other enforcement actions such as withholding of 
payments or converting to the reimbursement method of payment. 
Continued failure to submit required reports may result in the 
imposition of special award provisions, or cause other eligible 
projects or activities involving that grantee organization, or the 
individual responsible for the delinquency to not be funded. Failure to 
obtain prior approval for change in Scope, Principal Investigator, 
Grantee Institutions, Successor in Interest, or Recipient Institute 
Name, undertaking any activities disapproved or restricted as a 
condition of the award, may result in fund restrictions.
6. Other Submission Requirements
    Each submitted research project (including pilot research projects) 
must be budgeted so that it could stand on its own. That is, each 
project should be fundable under its own budget so that it could be 
completed even if none of the rest of the NARCH is funded. All things 
vital to each project should be included in the budget of that project 
and not included in the core. The NARCH core should include only 
administrative, training or other items that are non-essential to the 
research projects. The core should also include the capacity to take 
advantage, for training purposes, of any new research opportunity that 
becomes available to the grantee, whether through NARCH funding or 
other new resources. The core should be budgeted as if it were an 
additional project and the total amounts requested on the face page of 
the NARCH application should represent the sum of the projects plus the 
core. Each subcontractor participating in each project (or core) should 
submit its budget as part of that project's budget, using appropriate 
form pages from the PHS 398. Each project submission should include a 
set of budget pages from each of the institutional partners 
participating in that project. Each research project budget should 
explicitly include that portion of the grantee's indirect costs that 
are associated with activities under that project, including direction 
and oversight of the subcontracts. Each project (and core) must include 
a checklist and face page for that project. Only the main face page for 
the entire NARCH is required to have the signatures of the NARCH 
principal investigator and official signing for the applicant 
organization.
    Submit a typed and signed original application, including the 
checklist, and one 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 Suite 360, Rockville, MD 20852-1627 (zip code 
is unchanged for express/courier services), Phone: (301) 443-5204.
    At the time of submission, applicants must also send four 
additional single-sided photocopied and signed applications, including 
the Checklist, Appendices, and supporting documentation to: Center for 
Scientific Review, National Institutes of Health, 6701 Rockledge Drive, 
Room 6160--MSC 7892, Bethesda, MD 20892-7720, Bethesda, MD 20817 (for 
express or courier service). Phone: (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 http://www.ihs.gov/MedicalPrograms/Research/narch.cfm. They 
will also be sent to any potential applicant who e-mailed their contact 
information to [email protected] with the words ``technical assistance'' in 
the subject heading.

DUNS Number

    Applicants are required to have a Dun and Bradstreet (DUNS) number 
to apply for a grant or cooperative agreement from the Federal 
Government. The DUNS number is a nine-digit identification number, 
which uniquely identifies business entities. Obtaining a DUNS number is 
easy and there is no charge. To obtain a DUNS number, access http://www.dunandbradstreet.com or call 1-

[[Page 78582]]

866-705-5711. Interested parties may wish to obtain their DUNS number 
by phone to expedite the process.
    A DUNS number is required before Central Contractor Registry (CCR) 
registration can be completed. Many organizations may already have a 
DUNS number. Please use the number listed above to investigate whether 
or not your organization has a DUNS number. Registration with the CCR 
is free of charge.
    Applicants may register by calling 1-888-227-2423. Please review 
and complete the CCR Registration Worksheet located at http://www.grants.gov/CCRRegister.
    More detailed information regarding these registration processes 
can be found at http://www.grants.gov.

Electronic Research Administration (eRA) User Name

    Each NARCH Application's Principal Investigator is required to have 
a user name with the NIH eRA system. This also requires that the 
applicant institution (Tribe or Tribal organization) be an eRA Commons 
Registered Organization. A list of eRA Commons Registered Organizations 
can be found at http://era.nih.gov/commons/quick_queries/commons_registered_orgs.cfm. More information on the eRA Commons system can be 
found at http://era.nih.gov/.

V. Application Review Information

    Upon receipt, IHS and NIH staff will administratively review 
applications for completeness and responsiveness. Applications that are 
incomplete, non-responsive to this RFA, or do not follow the guidelines 
of the PHS form 398 (revised 11/2007) or of the supplementary 
instructions for NARCH grants (available at: http://www.ihs.gov/MedicalPrograms/Research/narch.cfm or from [email protected]), may be 
returned to the applicant without further consideration. Applications 
will be evaluated in accordance with the criteria stated below for 
scientific and technical merit by appropriate peer review groups 
convened by the CSR. The National Advisory General Medical Sciences 
Council will conduct the second level of review.
1. Criteria
    Priorities for funding will be based on the scientific and 
technical merit of the application, the assessed potential of 
investigators in the developmental stages of their careers, and the 
likelihood that the proposed project(s) can further the purposes of the 
NARCH initiative. Awards will be made only to organizations with 
financial management systems and management capabilities that are 
acceptable under HHS policy. Awards will be administered under the HHS 
Grants Policy Statement, January 2007.
A. Review of Student and Faculty/Researcher Development Plans
    The anticipated effectiveness of the proposed NARCH in making a 
difference relative to the current base-line data (based in part on 
previous experience of the NARCH) will be assessed. Factors to be 
considered include:
     The appropriateness of the content, phasing, quality, and 
duration of the student or faculty/researcher development plans in the 
NARCH application to achieve the scientific development of the faculty/
researcher, post-doctoral, pre-doctoral, undergraduate, and (if well 
justified) high school students; and
     The research experience and expertise, proposed 
commitment, and quality of the mentoring plan and of individual mentors 
of the partners in providing mentoring, guidance, and advice to 
candidates (including training in responsible conduct of research and 
research integrity, teaching, and protection of human subjects), and in 
fostering the development of academic and community-based AI/AN 
researchers.
B. Review of Research Projects
    The NIH has announced procedures to be used for the review of 
research grant applications (NIH Guide, Volume 26, Number 22, June 27, 
1997 or see http://grants.nih.gov/grants/guide/notice-files/not97-010.html and http://grants.nih.gov/grants/guide/notice-files/NOT-OD-05-002.html for additional updated information.) For NARCH applications, 
the five criteria listed in this announcement will be used for the 
scientific review of research projects and pilot research projects. The 
review of research projects and pilot research projects will be the 
same except that applications for pilot studies may be smaller in scope 
and would not be expected to have preliminary data.
    In the written comments, reviewers will be asked to discuss the 
following aspects of the application in order to judge the likelihood 
that the proposed research will have a substantial impact on the 
pursuit of these purposes. Each of these criteria will be addressed and 
considered in assigning the overall score, weighting them as 
appropriate for each application.
     Significance: Does this study address an important 
problem? If the aims of the application are achieved, how will 
scientific knowledge or clinical practice be advanced? What will be the 
effect of these studies on the concepts, methods, technologies, 
treatments, services, or preventative interventions that drive this 
field?
     Approach: Are the conceptual or clinical framework, 
design, methods, and analyses adequately developed, well integrated, 
well reasoned, and appropriate to the aims of the project? Does the 
applicant acknowledge potential problem areas and consider alternative 
tactics?
     Innovation: Is the project original and innovative? For 
example: Does the project challenge existing paradigms or clinical 
practice; address an innovative hypothesis or critical barrier to 
progress in the field? Does the project develop or employ novel 
concepts, approaches, methodologies, tools, or technologies for this 
area?
     Investigators: Are the investigators appropriately trained 
and well suited to carry out this work? Is the work proposed 
appropriate to the experience level of the principal investigator and 
other researchers? Does the investigative team bring complementary and 
integrated expertise to the project (if applicable)?
     Environment: Does the scientific environment in which the 
work will be done contribute to the probability of success? Do the 
proposed studies benefit from unique features of the scientific 
environment, or subject populations, or employ useful collaborative 
arrangements? Is there evidence of institutional support?
    In reviewing the overall Center, the initial scientific review 
group will examine evidence of the partners' commitment to the purposes 
of the NARCH initiative to develop a cadre of AI/AN scientists and 
health professionals engaged in biomedical, clinical, behavioral and 
health services research that is competitive for Federal funding; to 
increase the capacity of both research-intensive institutions and AI/AN 
organizations to work in partnership to reduce distrust by AI/AN 
communities and people toward research; and to encourage competitive 
research linked to the health priorities of the AI/AN partner and to 
reducing health disparities.
    The evidence will include:
     The quality of the partnership of the institutional and 
community partners, and the quality of the involvement of the Community 
and Scientific Advisory Council, as demonstrated by documentation of 
(for instance): The intellectual and tangible contributions and 
activities of the partners, and of the

[[Page 78583]]

Council, in developing the application and the proposed NARCH; the 
interactions of the partners, and of the members of the Council, in 
meetings (such as those to develop the application and proposed NARCH); 
the past activities and future plans to increase the capacity of the 
partners and of the Council; the plans for future contributions and 
activities by the partners, and by the Council, in furthering the goals 
of the proposed NARCH; and the plans for future development of the 
partnership itself;
     The experience and commitment of the institutional and 
community partners to recruit, retain, and advance AI/AN faculty/ 
researcher and students, to support faculty/researcher and student 
research efforts, and to increase the role of the involved AI/AN 
communities in the plans of the proposed NARCH;
     The appropriateness of the plan for evaluating the impact 
of the proposed NARCH, including the quality of baseline data and 
milestones for accomplishments, and a system to track the future course 
of program participants; and
     The potential of the proposed NARCH to be a regional and 
national resource, including: Capacity to provide quality research 
training and mentoring for integrated promotion and development of AI/
AN research careers from undergraduate (or if well justified, high 
school) through post-doctoral levels; attainment of quality research 
linked to health priorities of the AI/AN partner and to reducing health 
disparities; plans for research information dissemination and education 
activities; and plans for the development of research networks to 
support the scientific aims of the proposed NARCH. For competitive 
renewal applications, reviewers will also assess the previous 
accomplishments and progress of the applicants.
    In addition to the above criteria, in accordance with NIH policy, 
all applications will also be reviewed with respect to the following:
     The adequacy of plans, if research on human subjects is 
involved, to include both genders and children as appropriate for the 
scientific goals of the research. Plans for the recruitment and 
retention of subjects will also be evaluated.
     For applications that are competing renewals of existing 
NARCH centers, has significant progress been achieved toward each of 
the originally proposed projects?
     The reasonableness of the proposed budget and duration in 
relation to the proposed research.
     The adequacy of the proposed protection for humans, 
animals or the environment, to the extent they may be adversely 
affected by the project proposed in the application.
     The adequacy of the proposed plan to share data, if 
appropriate.

VI. Award Administration Information

1. Award Notices
    The Notice of Award (NoA) will be initiated by the IHS Division of 
Grants Operations (DGO) and will be mailed via postal mail to each 
entity that is approved for funding under this announcement. The NoA 
will be signed by the Grants Management Officer and this is the 
authorizing document for which funds are dispersed to the approved 
entities. The NoA will serve as the official notification of the grant 
award and will reflect the amount of Federal funds awarded, the purpose 
of the grant, the terms and conditions of the award, the effective date 
of the award, and the budget/project period. The NoA is a legally 
binding document. Applicants who are approved but unfunded or 
disapproved based on their objective review score will receive a copy 
of the Executive Summary which identifies the weaknesses and strengths 
of the application submitted.
2. Administrative and Policy Requirements
    A. Grants are administrated in accordance with the following 
documents:
     This Announcement.
     Administrative Requirements: 45 CFR part 92, (Uniform 
Administrative Requirements for Grants and Cooperative Agreements to 
State, Local and Tribal Governments, (or 45 CFR part 74, (Uniform 
Administrative Requirements for Awards to Institutions of Higher 
Education, Hospitals, Other Non-Profit Organizations, and Commercial 
Organizations.
     Grants Policy Guidance: HHS Grants Policy Statement, 
January 2007.
     Cost Principles: OMB Circular A-87, (State, Local, and 
Indian (Title 2 Part 225).
     Cost Principles: OMB Circular A-122, (Non-profit 
Organizations (Title 2 Part 230).
     Audit Requirements: OMB Circular A-133, (Audits of States, 
Local Governments, and Non-profit Organizations).
    B. Inclusion of Women and Minorities in Research Involving Human 
Subjects:
    It is the policy of the NIH that women and members of minority 
groups and their subpopulations must be included in all NIH supported 
biomedical, clinical, behavioral, and health services research projects 
involving human subjects, unless a clear and compelling rationale and 
justification is provided that inclusion is inappropriate with respect 
to the health of the subjects or the purpose of the research. This 
policy results from the NIH Revitalization Act of 1993 (Section 492B of 
Pub. L. 103-43). Because the NARCH initiative targets AI/AN people and 
communities, a minority population, only the policy of inclusion of 
women applies to this RFA. The IHS has fully accepted the Office for 
Human Research Protections (OHRP) policy regarding human subjects. The 
OHRP Web site is http://www.hhs.gov/ohrp/. All investigators proposing 
research involving human subjects should read the Updated NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research, published in the NIH Guide for Grants and Contracts 
on August 2, 2000. (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-048.html). The complete Guidelines are available at: http://grants1.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm . The revisions relate to NIH defined Phase III clinical 
trials and require:
     All applications or proposals and/or protocols to provide 
a description of plans to conduct analyses, as appropriate, to address 
differences by sex/gender and/or racial/ethnic groups, including 
subgroups if applicable; and
     All investigators to report accrual, and to conduct and 
report analyses, as appropriate, by sex/gender and/or racial/ethnic 
group differences.
C. Inclusion of Children as Participants in Research Involving Human 
Subjects
    It is the policy of NIH that children (i.e., individuals under the 
age of 21) must be included in all human subjects research, conducted 
or supported by the NIH, unless there are scientific or ethical reasons 
not to include them. This policy applies to all initial (Type 1) 
applications submitted. All investigators proposing research involving 
human subjects should read the NIH Policy and Guidelines on the 
Inclusion of Children as Participants in Research Involving Human 
Subjects that was published in the NIH Guide for Grants and Contracts, 
March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html. Investigators 
may obtain copies of these policies from the initiative staff listed 
under VII. Agency Contacts. Initiative staff may also provide 
additional

[[Page 78584]]

relevant information concerning the policy.
D. URLS in NIH Grant Applications or Appendices
    All applications and proposals for NIH funding must be self-
contained within specified page limitations. Unless otherwise specified 
in an NIH solicitation, Internet addresses (URLs) should not be used to 
provide information necessary to the review because reviewers are under 
no obligation to view the Internet sites. Reviewers are cautioned that 
their anonymity may be compromised when they directly access an 
Internet site.
E. Allowable Administrative Costs
    Certain administrative costs for managing a comprehensive program 
are allowable and may vary, depending upon the size and complexity of 
the program's activities. The costs budgeted for NARCH grants and 
subcontracts may not duplicate items already budgeted in other cost 
centers of the AI/AN, research-intensive, and subcontracted 
organizations and institutions, such as accounts which make up the 
Facilities and Administration (F&A) cost pool. The grantee organization 
receiving the award must be prepared to provide documentation showing 
the direct relationship of proposed costs to the program, and that 
costs of this type are charged in a uniform manner to all other grants 
at all institutions and organizations participating in the award.
    Limited salary support for secretarial or clerical help is 
allowable only when in direct support of the proposed NARCH project. 
For guidance, applicants should refer to the OMB Circular appropriate 
for them, A-87 (Cost Principles for State, local, and Indian Tribal 
Governments), at http://www.whitehouse.gov/omb/circulars or A-122 (Cost 
Principles for Non-Profit Organizations), at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://http://www.whitehouse.gov/omb/circulars, or should contact the Grants 
Management Officer listed under VII. Agency Contacts.
    Costs for evaluation activities are allowable, as are costs for the 
Community and Scientific Advisory Council. All research project 
applications must include costs associated with one annual meeting per 
year in Rockville, MD, of the project Principal Investigator(s) and 
their key scientific personnel. Research project applications should 
also include costs associated with attendance for key personnel and 
presenters to the annual Native Health Research Conference. NARCH core 
and/or training budgets should include these travel costs for key NARCH 
personnel and trainees who are not associated with specific research 
projects.
    Student Development Costs: Student (graduate, undergraduate, and 
high school if well justified) remuneration through salary/wages for 
participation in research experiences may be requested, provided all 
the following conditions are met:
    I. The student is performing necessary work involved in the 
research;
    II. There is an employer-employee relationship between the student 
and the proposed NARCH or its partners;
    III. The total compensation is reasonable for the work performed; 
and
    IV. It is the practice of the proposed NARCH or its partners to 
provide compensation for all students in similar circumstances, 
regardless of the source of support for the activity.
    Graduate students, but not undergraduate students, are allowed 
tuition costs as part of a compensation package. When requesting 
support for a graduate student, the NARCH application should provide, 
in the budget justification section of the application, the basis for 
the compensation level. The IHS staff will review the requested 
compensation level and, if it is reasonable and justified, will provide 
compensation up to a maximum of $45,000 (http://grants.nih.gov/grants/guide/notice-files/not98-168.html). Post-doctoral students should be 
compensated at a rate commensurate with that of other post-doctoral 
employees with similar degrees and experience at the research-intensive 
institution. It is the expectation of the IHS and NIGMS that students 
who are enrolled in a accredited graduate program, as part of a 
proposed NARCH, will not be excluded from support from other non-
Federal or Federal graduate training sources (such as loans and 
assistance under the Veterans' Adjustment Benefit Act or Pell Grants) 
for which they are eligible.
    Graduate and post-doctoral students cannot concurrently hold other 
Federally-sponsored stipends or fellowship or any other Federal award 
that duplicates the NARCH support.
Faculty/Researcher Development Costs
    Costs to support faculty/researcher development activities, such as 
workshops or courses, national meetings, or short-term research 
experiences in the laboratory of an active NIH-extramurally-funded 
researcher needed for acquiring specific skills or methodologies needed 
for prospective research, are allowable. Such costs might include 
tuition, travel and per diem costs, as well as salary support 
appropriate to the percent effort needed for the activity.
Research Project Costs
    Direct costs associated with research and pilot research projects 
are allowable when adequate justification is provided. These include 
faculty/researcher salaries, reimbursed according to percent effort. 
Summer salary support can be paid provided the institution's academic 
schedule permits such release and when the institution approves. The 
maximum summer-salary support provided by the program cannot exceed the 
equivalent of three months at 100 percent effort, or time specified by 
the institution as its policy. Grant funds may not be used to increase 
or supplement faculty/researcher academic year salaries. Salary support 
for technical assistance and costs for consultants, if justified, are 
allowable. Costs for equipment to be used to carry out the proposed 
research are allowable.
Cost for Supplies
    Costs for supplies, including costs for animals necessary to carry 
out the proposed research, may be included. Travel costs for the 
investigator(s) and staff are permitted to required meetings or when 
direct benefits to the program are expected, and when adequate 
justification is provided. Alterations and renovations costs (up to 
$40,000) are allowable only when essential for conduct of the proposed 
research. Other permitted costs include animal maintenance (unit care 
costs and number of care days), donor fees, publication costs, computer 
charges, rentals and leases, equipment maintenance, and service 
contracts.
Consortium and Contract Arrangements
    Consortium arrangements that may involve personnel costs, supplies, 
and other allowable costs, including overhead costs; contractual costs 
for support services, such as the laboratory testing of biological 
materials, clinical services, data processing, or core administrative 
services, are allowable expenses. Consortia and contractual costs with 
Native health organizations, Tribes and/or research institutions in 
Canada or Mexico are allowable expenses.
Pilot Research Projects
    The intent of pilot research projects is to lead to regular 
research projects funded as part of the center grant or as freestanding 
grants. For pilot research projects, applications may request

[[Page 78585]]

support for up to $75,000 (direct costs) per year for up to four years. 
Pilot research investigators considering project periods of less than 
four years are encouraged to consider the fact that initiation of a new 
research activity in a new population often takes much longer than 
originally anticipated and that the creation of a trusting relationship 
between the investigator and the community is both vital and time 
consuming. NARCH pilot research support is non-renewable. However, 
NARCH research projects based on prior NARCH pilot research projects 
are encouraged.
Subcontracts
    The grant recipient may issue subcontracts to other organizations 
(such as the research-intensive institution of the partnership), as 
long as a minimum of 30 percent of the grant funds are 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.
F. Unallowable Costs
    Unallowable costs for research projects (including for pilot 
projects) include costs for student development, textbooks, journals, 
memberships, and Internet subscription costs, as well as other costs 
prohibited by OMB Circulars A-87 or A-122 as applicable. Employees of 
the applicant organization may not serve as paid consultants but may be 
paid. The pilot research project is intended for faculty/researcher 
without current Federal research support. Therefore, investigators with 
significant current support from other mechanisms such as the R01 and 
research funding from other extramural sources are not eligible, and 
the costs therefore are not allowable. Release time for preparing 
proposals or mini-research projects, not submitted as pilot projects, 
is not allowed.
G. Research Subjects Protection
    Under governing policy, Federal funds administered by the HHS shall 
not be expended for research involving live vertebrate animals without 
prior approval by the NIH Office of Laboratory Animal Welfare (OLAW), 
of an assurance to comply with the Public Health Service (PHS) Policy 
on Humane Care and Use of Laboratory Animals. This restriction applies 
to all performance sites (e.g., collaborating institutions, 
subcontractors, subgrantees) without OLAW-approved assurances, whether 
domestic or foreign. Funds included in this award may not be used to 
support studies using live vertebrate animals until approval from the 
Institutional Animal Care and Use Committee (IACUC) has been received 
by the IHS Grants Management Officer (GMO).
    Federal Regulations (45 CFR, Part 46) require that applications and 
proposals involving human subjects must be evaluated with reference to 
the risks to the subjects, the adequacy of protection against these 
risks, the potential benefits of the research to the subjects and 
others, and the importance of the knowledge gained or to be gained. 
Under governing regulations 45 CFR part 46, found at http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm, Federal funds 
administered by HHS shall not be expended for research involving human 
subjects, and individuals shall not be enrolled in such research, 
without prior approval by the Office for Human Research Protections 
(OHRP), of an appropriate Federal Wide Assurance (FWA) and prior 
approval by an Institutional Review Board (IRB) recognized and listed 
by the OHRP. Funds included in this award may not be used to support 
studies using human subjects until evidence of IRB approval has been 
received by the IHS GMO. Grantees are expected to provide their own 
institutional FWA.
H. Research Integrity
    Grantees shall comply with Public Health Service Policies on 
Research Misconduct (42 CFR part 93) which require grantees to have 
procedures for responding to allegations of research misconduct that 
comply with those policies, to submit their procedures to the Office of 
Research Integrity (ORI) (http://ori.hhs.gov) upon request for review, 
and revise their procedures in accordance with ORI comments. In 
addition, grantees shall file the Annual Report on Possible Research 
Misconduct with ORI at http://www.ori.dhhs.gov/assurance/electronic_submission.shtml.
    Grantees shall file documentation of their Annual Reports with the 
IHS GMO.
I. Healthy People 2010
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2010, a PHS led national activity for setting priority areas. This RFA 
announcement is related to one or more of the priority areas. Potential 
applicants may obtain a copy of Healthy People 2010 at: http://www.healthypeople.gov.
3. Indirect Costs
    This section applies to all grant recipients that request 
reimbursement of indirect costs in their grant application, but not to 
the indirect costs that may be negotiated by the grantees with their 
subcontractors (which become direct costs to the grantee). In 
accordance with HHS Grants Policy Statement, Part II-27, IHS requires 
applicants to have a current indirect cost rate agreement in place 
prior to award. The rate agreement must be prepared in accordance with 
the applicable cost principles and guidance as provided by the 
cognizant agency or office. A current rate means the rate covering the 
applicable activities and the award budget period. If the current rate 
is not on file with the DGO at the time of award, the indirect cost 
portion of the budget will be restricted and not available to the 
recipient until the current rate documentation is provided to the DGO.
    Generally, indirect costs rates for IHS grantees are negotiated 
with the Division of Cost Allocation http://rates.psc.gov/ and/or the 
Department of the Interior (National Business Center) http://www.nbc.gov/acquisition/ics/icshome.html. If your organization has 
questions regarding the indirect cost policy, please contact the DGO at 
(301) 443-5204.
4. Reporting
    A. Progress Report. Program progress reports are required semi-
annually. These reports will include a brief comparison of actual 
accomplishments to the goals established for the period, or, if 
applicable, provide sound justification for the lack of progress, and 
other pertinent information as required. A final annual progress 
report, cumulative from the beginning of the project period, must be 
submitted within 90 days of expiration of each budget period.
    B. Financial Status Report. Quarterly financial status reports must 
be submitted within 30 days of the end of each quarter. Final financial 
status reports are due within 90 days of expiration of the budget/
project period. Standard Form 269 (long form) will be used for 
financial reporting.
    C. Reports. Grantees are responsible and accountable for accurate 
reporting of the Progress Reports and Financial Status Reports. 
Financial Status Reports (SF-269) are due 90 days after each budget 
period and the final SF-269 must be verified from the grantee records 
on how the value was derived. Grantees must submit reports in a 
reasonable period of time.
    Failure to submit required reports within the time allowed may 
result in

[[Page 78586]]

suspension or termination of an active grant, withholding of additional 
awards for the project, or other enforcement actions such as 
withholding of payments or converting to the reimbursement method of 
payment. Continued failure to submit required reports may result in one 
or both of the following: (1) The imposition of special award 
provisions; and (2) the non-funding or non-award of other eligible 
projects or activities. This applies whether the delinquency is 
attributable to the failure of the grantee organization or the 
individual responsible for preparation of the reports.
5. Telecommunication for the Hearing Impaired is Available at: TTY 
(301) 443-6394.

VII. Agency Contact(s)

    1. Questions on the initiative regarding IHS NARCH issues and 
policies may be directed to: Alan Trachtenberg, M.D., M.P.H., Division 
of Planning, Evaluation and Research, Indian Health Service, 801 
Thompson Avenue, TMP Suite 450, Rockville, MD 20852, Phone: (301) 443-
4700, Fax: (301) 443-0114, e-mail: [email protected].
    2. Questions on grants management and fiscal matters may be 
directed to: Sylvia Ryan, Division of Grants Operations, Indian Health 
Service, Reyes Building, 801 Thompson Avenue, TMP Suite 350, Rockville, 
MD 20852, Phone: (301) 443-5204, Fax: (301) 443-9602, e-mail: 
[email protected].
    3. Questions on NIH and NIGMS issues and policies, may be directed 
to: Clifton A. Poodry, Ph.D., Minority Opportunities in Research 
Division, National Institute of General Medical Sciences, 45 Center 
Drive, Suite 2AS.37, MSC 6200, Bethesda, MD 20892, Phone: (301) 594-
3900, Fax: (301) 480-2753, e-mail: [email protected].
    4. Questions on the review of applications may be directed to: 
Mushtaq A. Khan, D.V.M., Ph.D., Chief, Digestive and Respiratory 
Sciences IRGs, Center for Scientific Review, MSC 7818, Room 2176; 6701 
Rockledge Drive; Bethesda, MD 20892 (20817 for courier or express 
service) Phone: (301) 435-1778; Fax: (301) 451-2043; e-mail: 
[email protected].

VIII. Other Required Documents

    If the applicant is a federally-recognized Tribe, Tribal 
organization, or a Tribal college, letters of support from the 
Chairman, President, Governor, or Tribal Health Director is required of 
all Tribes to be served to show their support of the grant project. 
Letters of support are intended to document that applicants have Tribal 
support for the specific grant for which they are applying. All letters 
of support must accompany the grant application.

IX. Other Information

References for Background Information:
    Anderson, N.B. Levels of analysis in health science: A framework 
for integrating sociobehavioral and biomedical research. Annals of 
the New York Academy of Sciences, 1998, 840, 563-576.
    Ballantine, B., Ballantine, I. (Eds.), Thomas, D.H., Miller, J., 
White, R., Nabokov, P., Deloria, P.J. (Text by), Joseph, A.M. 
(Intro.) The Native Americans: An Illustrated History. Turner 
Publishing, Inc. Atlanta, GA, 1993.
    Freeman, W.L. The role of community in research with stored 
tissue samples. Weir R (Ed.) Stored tissue samples: Ethical, legal, 
and public policy implications. University Iowa Press. Iowa City, 
IA, 1998, 267-301.
    Gazmararian, J.A., Baker, D.W., Williams, M.V., Parker, R.M., 
Scott, T.L., Green, D.C., Fehrenbach, S.N., Ren, J. & Koplan, J.P. 
Health literacy among Medicare enrollees in a managed care 
organization. Journal of the American Medical Association, 1999, 
281, 545-551.
    Haynes, M.A. & Smedley, B.D. (Eds.) The Unequal Burden of 
Cancer: An Assessment of NIH Programs for Ethnic Minorities and the 
Medically Underserved. Institute of Medicine. National Academy 
Press. Washington, DC, 1999.
    Macaulay, A.C., Commanda, L.E., Freeman, W.L., Gibson, N., 
McCabe, M.L., Robbins, C.M., & Twohig, P.L., (for the) North 
American Primary Care Research Group. Participatory research 
maximizes community and lay involvement. British Medical Journal, 
1999, 319, 774-778.
    Minority Economic Profiles. U.S. Bureau of the Census, 
Population Division. Issued July 24, 1992. (Tables 1990 CPH-L-92, 
93, 94 and 95).
    NIH Publication 98-4247. Women of Color Health Data Book. Office 
of Research On Women's Health, National Institutes of Health, 1998.
    Trends in Indian Health 1998-99. Program Statistics Team, Office 
of Public Health, Indian Health Service, 2001.
    Regional Differences in Indian Health 1998-99. Program 
Statistics Team, Office of Public Health, Indian Health Service, 
2000.
    Weiss, B.D., Reed, R.L., & Kligman, E.W. Literary skills and 
communication methods of low-income older persons. Patient Education 
and Counseling, 1995, 25, 109-119.
    Williams, D.R. & Collins, C. U.S. Socioeconomic and Racial 
Differences in Health: Patterns and Explanations. Annual Review of 
Sociology, 1995, 21, 349-386.
    Williams, M.V., Parker, R.M., Baker, D.W., Parikh, N.S., Pitkin, 
K., Coates, W.C., & Nurss, J.R. Inadequate functional health 
literacy among patients at two public hospitals. Journal of the 
American Medical Association, 1995, 274, 1677-1682.

    Dated: December 15, 2008.
Robert G. McSwain,
Director, Indian Health Service.
 [FR Doc. E8-30300 Filed 12-19-08; 8:45 am]
BILLING CODE 4165-16-P