cancercontrol.cancer.gov/brp

Resources and Support for Implementation Science and

Tobacco Control at NIH

NIH Fogarty International Center https://www.fic.nih.gov/researchtopics/pages/implementationscience.aspx

NIH Fogarty International Center https://www.fic.nih.gov/researchtopics/pages/implementationscience.aspx

NIH Office of Behavioral and Social Science Research

(OBSSR) https://obssr.od.nih.gov/scientific-initiatives/dissemination-and-implementation/

National Cancer Institute https://cancercontrol.cancer.gov/IS/

National Heart, Lung and Blood Institute https://www.nhlbi.nih.gov/about/org/ctris/

NIH Resources Dissemination and Implementation Science

• Training programs

– Training Institute for Dissemination and Implementation Research in Health

– NCI Implementation Science Team Masters Courses and Webinar Series

• Conferences

– Conference in the Science of Dissemination and Implementation in Health,

December 4-5, 2017

• Online courses and materials

– FIC Toolkit Overcoming Barriers to Implementation in Global Health

– Research to Reality online forum for cancer control researchers and

practitioners

NIH D&I Funding Opportunity

• Open to Foreign Institutions

• Three different mechanisms – R01, R21, R03

• Studies of strategies to implement health promotion, prevention, screening,

early detection, and diagnostic interventions, as well as effective

treatments, clinical procedures, or guidelines in existing care systems.

cancercontrol.cancer.gov/brp

Current Tobacco Control Funding Initiatives at NCI

10

Tobacco Control as a Global Cancer Research Priority

• November 2012 – Research leaders from 15 countries

came to NIH to discuss priorities in global cancer

research.

• With respect to modifiable lifestyle risk factors for

cancer, there is a consensus that tobacco use remains,

by far, the most important at a global level.

• Measures that can already be taken to control tobacco

use include removing tobacco products from trade

agreements, increasing taxes on tobacco products,

controlling tobacco industry marketing, and building

support among health professionals.

Source: H. Varmus, H. S. Kumar, Addressing the growing international challenge of

cancer: A multinational perspective. Sci. Transl. Med. 5, 175cm2 (2013).

11

TCRB International Research Webpage http://cancercontrol.cancer.gov/brp/tcrb/international/

12

NCI International Tobacco Control Grants

NCI has supported tobacco control research grants in

more than 40 countries around the world

13

NCI Global Tobacco Control Grants Areas of Research

Percent of Total

FY 2002–Present (N=56)*

NIH International Tobacco and Health Research and

Capacity Building Program https://www.fic.nih.gov/programs/pages/tobacco.aspx

15

The International Tobacco and Heath Research and Capacity Building Program (TOBAC) Country Collaborators, 2001-2016

Source: https://www.fic.nih.gov/programs/pages/tobacco.aspx

Co-funded by FIC, NCI and NIDA

Features of the TOBAC Program: Special

Requirements

• Collaboration: Requires both PI from US/HIC and PI from LMIC.

• Relevant Research Priorities: Demonstrate how proposed research reflects

the priorities of the collaborating LMIC

• Dissemination: Dissemination plan should describe how results will

support tobacco control in the host country.

• Continued Collaboration: Plan for continued collaboration and mentoring

after initial training period

• Network meetings: Budget for periodic grantee network meetings

• Evaluation: Track long term impact of training and capacity building efforts

and use of research findings in country.

Rationale:

Growth in waterpipe smoking in Eastern Mediterranean region and other

parts of the world, especially among young adults, combined with

widespread misperceptions that waterpipe smoking is less harmful and

addictive than cigarette smoking.

Specific Aims:

• Develop health warning labels specific to waterpipe tobacco smoking

using focus groups in Lebanon and Tunisia

• Evaluate warning labels with 400+ young adults (18 – 25 years) in each

country assessing reaction, harm perception, quit intentions, and

perceived effectiveness

• Key informant interviews with government officials and NGOs to assess

capacity and possible barriers to implementation

Translating evidence and building capacity to support waterpipe

control in the Eastern Mediterranean (PI: Maziak, W.)

18

NCI DCCPS Organizational Structure

Division of Cancer Control

and Population Sciences (DCCPS)

Epidemiology and

Genomics Research

Program

Behavioral

Research

Program

Healthcare Delivery

Research

Program

Surveillance

Research

Program

The Behavioral Research Program (BRP) initiates, supports, and evaluates a

comprehensive program of research including basic behavioral and

psychological science as well as the development, testing, and dissemination

of interventions in cancer control areas such as tobacco use, diet and energy

balance, and sun protection.

cancercontrol.cancer.gov/brp/

19

How We Fund Grants

Although most of our portfolio consists of investigator-initiated (unsolicited) grants,

BRP also supports grant applications in specific areas of interest

Requests for Applications (RFA)

Identifies the specific receipt date(s), the estimated amount of funds earmarked for the initiative, the

number of awards likely to be funded, and any specific criteria for scientific peer review; applications

re ei ed in response to a parti ular RFA are re ie ed y an Institute’s S ientifi Re ie Group

Program Announcements (PA)

Most PA applications are submitted with a standing receipt date and are reviewed with all other

applications received at that time using standard peer-review processes

Program Announcement (PAR)

Program announcements with special receipt, referral, and/or review considerations

For more information: cancer.gov/grants-training/grants-process/grants-process.pdf

20

Grant Recipients

A grant provides federal financial assistance, including money, property, or both to an eligible

entity to perform approved scientific activities with little or no government involvement

Nonprofit organizations

For-profit organizations

Institutions of higher education

Hospitals

Research foundations

State, local, and tribal governments

Federal institutions

Foreign institutions and international organizations (varies by announcement)

Other organizations (e.g., school districts, faith-based, public housing)

See each FOA for scientific disciplines of interest and transdisciplinary considerations For more information: cancer.gov/grants-training/grants-process/grants-process.pdf

21

Grant Mechanisms – R01 and R21

NIH Research Project Grant

(R01)

NIH Exploratory/Developmental Grant

(R21)

Used to support a discrete, specified, and

circumscribed research project

NIH's most commonly used grant program

No specific dollar limit unless specified in

Funding Opportunity Announcement (FOA)

Advance permission required for $500K or

more (direct costs) in any year

Generally awarded for 3-5 years

Encourages new, exploratory, and

developmental research projects by

providing support for early stages of project

development

Sometimes used for pilot and feasibility

studies

Limited to up to two years of funding

Combined budget for direct costs for the

two-year project period usually may not

exceed $275,000

No preliminary studies are required

For more information: grants.nih.gov/grants/funding/funding_program.htm#RSeries

22

Tobacco Use and HIV in Low and Middle Income

Countries (LMICs)

PAR-17-087 (R01) & PAR-17-086 (R21) Contact:

Mark Parascandola

301-841-5474

paramark@mail.nih.gov

Funding Announcements

Tobacco Use and HIV in Low and Middle Income Countries (LMICs)

PAR-17-087 [R01]

https://grants.nih.gov/grants/guide/pa-files/PAR-17-087.html

PAR-17-086 [R21]

https://grants.nih.gov/grants/guide/pa-files/PAR-17-086.html

National Institute on Drug Abuse (NIDA) is participating with NCI

Grants can be submitted to either NIDA or NCI, and either Institute can be named as a secondary assignment

Goals of Funding Announcement

Encourage research focused on tobacco use and HIV/AIDS in low and middle income countries (LMICs). In particular, applications are encouraged that focus on the development and evaluation of tobacco cessation interventions tailored to HIV positive populations, including those with co-morbidities such as tuberculosis (TB), in low-resource settings.

Novel, transdisciplinary nature of addressing tobacco use in context of HIV in LMICs

Bring together investigators from diverse disciplines and research foci to pool their efforts on this syndemic

Encourage sharing of research strategies and data across disciplines and geographic regions

Dedicated review group with experience in LMICs and both tobacco and HIV

PAR = no set aside funding

Background: Tobacco and HIV/AIDS

Smoking prevalence higher among PLHIV compared with general

population

PLHIV who smoke tobacco suffer greater morbidity and mortality than

non-smoking counterparts

PLHIV who smoke have higher risk of infection, greater progression from

HIV to AIDS, and weaker response to anti-retroviral therapy (ART)

Introduction of ART has led to decline in AIDS mortality and increased

life expectancy for PLHIV, increasing risk for NCDs and related behavioral

risk factors

Existing HIV and TB prevention and treatment guidelines do not include

a focus on tobacco use

Opportunities and Challenges

HIV and TB treatment context provides opportunity to intervene around tobacco use

Existing infrastructure for community interventions

Diagnosis of HIV/AIDS or TB provides teachable moment

However, smoking cessation interventions for PLHIV present additional challenges

Lower cessation rates

Complications with other substance abuse, mental illness, socio-economic status

Bulk of the evidence base for tobacco cessation comes from HICs

LMICs may have limited access to pharmacologic treatments, fewer trained health professionals, weaker tobacco control policies

Need for tailored interventions in LMIC context

Sample of Example Research Questions

What types of tobacco cessation interventions are most effective in persons with HIV,

with or without TB co-infection, to achieve improved tobacco abstinence as well as

disease treatment outcomes in low-resource environments?

What are the barriers to integrating tobacco control interventions into the existing HIV

and TB prevention and treatment context in LMICs?

What is the cost-effectiveness of integrating smoking cessation within HIV and TB

treatment? What interventions can be effectively introduced to low-resource settings in

LMICs?

How does the social and behavioral context of tobacco use in PLHIV in LMICs, including

the use and abuse of other substances, influence tobacco use behavior and cessation

outcomes?

What policy interventions could be embedded in HIV and TB control programs that

would serve to improve the outcomes of cessation or prevention efforts at both a clinical

and population level?

28

Evaluation Criteria

Standard Review Criteria:

Significance, Investigator(s), Innovation, Approach, Environment

Specific to this FOA:

Is the study or intervention appropriate for LMIC settings?

Can the intervention be scaled up and implemented in the setting in which it is being

studied?

Does the project provide a well-developed plan for dissemination of research results

to the LMIC countries where the research is taking place?

29

Other Important Information

Applications will be evaluated by reviewers with relevant expertise in HIV/AIDS,

tobacco control, and global health

R01s are 3-5 year grants, which require preliminary studies

R21s are 2-year grants, which are considered exploratory and do not require

preliminary studies

Non-domestic (non-U.S.) Entities (Foreign Institutions) are eligible to apply.

Grants ith dire t osts ≥ $500,000 in any year require Program approval for

submission

Submit materials to Program Director at least 8 weeks prior to receipt

https://grants.nih.gov/grants/guide/notice-files/NOT-CA-02-029.html

https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html

30

Improving Smoking Cessation

in Socioeconomically Disadvantaged Populations

via Scalable Interventions

PAR-16-202 (R01) & PAR-16-201 (R21) Contact:

Yvonne Hunt

240-276-6975

yvonne.hunt@nih.gov

31

Improving Smoking Cessation – R01/R21

Background – Smoking in the U.S. is increasingly concentrated among

socioeconomically disadvantaged (SED) populations, leading to marked

smoking-related health disparities

SED populations have less access to empirically validated treatments, face

more obstacles to engage in and maintain behavior change, and are less likely

to use treatments

PAR Purpose – Develop and test scalable smoking cessation interventions

with the potential to improve cessation outcomes among socioeconomically

disadvantaged populations

32

Improving Smoking Cessation – R01/R21

Emphasis:

Interventions that have the potential to be scalable, implementable, and

sustainable in real-world settings

General Research Approaches:

Test enhancements of interventions currently scaled or ready to scale

Evaluation of existing interventions which could be scaled if evidence supports

Requirements:

Justify how the intervention can be scaled and packaged for broad use

Propose a testable hypothesis related to the scalability of the intervention

33

Improving Smoking Cessation – R01/R21

Example Research Questions:

In what ways can scalable interventions be developed or modified to

increase engagement with treatment and enhance long-term behavioral

change?

What strategies might be used to systematically increase access to and

utilization of cessation services in socioeconomically disadvantaged

populations?

How might available infrastructures that provide services to

socioeconomically disadvantaged populations be utilized to also deliver

smoking cessation interventions?

34

Improving Smoking Cessation – R01/R21

Targeted Subpopulations – SED smokers (e.g., low income, low educational

attainment, un- or underemployed, un- or underinsured, racial/ethnic

groups living in low-resource communities, other disadvantaged groups such

as veterans, incarcerated)

Transdisciplinary Approach – Teams may include public health, clinical,

behavioral, and social scientists, statisticians, economists, technology

developers, researchers with expertise in dissemination and implementation

Not Intended to Support:

Observational studies describing factors that influence cessation behavior,

treatment engagement, implementation or dissemination in real-world

contexts; studies for which smoking cessation is not an end-point; studies to

test interventions for cessation of non-combustible tobacco products

35

Mobile Health: Technology and Outcomes in

Low and Middle Income Countries (R21)

PAR-16-292 (R21) Contact:

Mark Parascandola

301-841-5474

paramark@mail.nih.gov

36

Mobile Health: Technology and Outcomes in Low and Middle Income Countries (R21)

Background – Enormous potential for mobile technology to transform

health care, personal health management, and basic health research.

The potential of mHealth is especially relevant to LMICs, where cell

phone ownership is rising rapidly, but access to health care and

providers is often limited. While there has been a large increase in

interventions that use mobile phones, research on these interventions

is often lacking.

Definition of mHealth – The use of mobile and wireless devices (cell

phones, tablets, etc.) to improve health outcomes, health care

services, and health research.

37

Research Objectives

This FOA encourages research projects that study the

development/adaptation of mHealth interventions for the prevention,

diagnosis, management, and treatment of specific health conditions.

Applicants are encouraged to propose research projects that have the

potential to provide an understanding of principles underlying effective

mHealth interventions or tools that are generalizable to the field.

This initiative aims to support projects that adapt or develop

technologies that are appropriate for LMIC settings. A plethora of

mHealth applications and devices have been developed in high-

income countries, however, these technologies are not necessarily

suitable for the needs of individuals in LMICs.

38

Special Requirements

All projects are required to involve partnerships between U.S. and

LMIC researchers and to develop mHealth research capacity at LMIC

institutions that can continue beyond the period of the grant.

Applicants should consider appropriate collaborations with

researchers from diverse disciplines such as behavioral science,

engineering, computer science, business, medicine, public health,

and/or other relevant fields.

In addition, applicants should consider partnering with individuals in

public or private organizations, including health system entities, which

could enable future research or implementation efforts within the

relevant LMIC.

39

Other Important Information

Non-domestic (non-U.S.) Entities (Foreign Institutions) are eligible to apply.

Participating NIH Institutes and Centers include: Fogarty International Center,

National Cancer Institute, National Institute on Deafness and Other

Communication Disorders, National Institute of Mental Health, National

Institute of Biomedical Imaging and Bioengineering

FIC Contact: Laura Povlich, Ph.D.

Fogarty International Center (FIC (http://www.fic.nih.gov))) Telephone: 301-

827-2227

Email: laura.povlich@nih.gov (mailto:laura.povlich@nih.gov)

NCI Contact: Vidya Vedham, Ph.D.

National Cancer Institute (NCI (http://www.nci.nih.gov/)) Telephone: 240-276-

7272

Email: vidya.vedham@nih.gov (mailto:vidya.vedham@nih.gov)

Questions

Tobacco and HIV in Low and Middle Income Countries (LMICs)

41

Are these funding opportunities only offered to interventions

conducted in the U.S.? Are projects conducted overseas going

to be funded? Do you have to be a U.S. citizen or have a green

card to apply for funds?

42

Can a new investigator receive special accommodation in

review?

43

Resources for New Funding Announcements

Funding Opportunities, Webinars and list of FAQs for funding announcements:

http://cancercontrol.cancer.gov/funding-foa-applicants.html

There, you can also find links to FOAs and Program Director contact information

Connect with any BRP staff member via contact information listed on:

http://staffprofiles.cancer.gov/brp/

Email questions to BRP anytime at ncidccpsbrpadvances@mail.nih.gov

Subscribe or unsubscribe from NCI/BRP email updates at

http://cancercontrol.cancer.gov/brp/e-newsletter/subscribe.html

1 - 8 0 0 - 4 - C A N C E R

U.S. Department of Health & Human Services

National Institutes of Health | National Cancer Institute

cancercontrol.cancer.gov/brp

Produced February 2017