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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


RELEASE DATE:  June 20, 2002
RFA:  TW-03-001
Fogarty International Center (FIC) 
Health Research Services Administration (HRSA) 
National Center on Minority Health and Health Disparities (NCHMD)
National Human Genome Research Institute (NHGRI)
National Institute of Allergy and Infectious Diseases (NIAID)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute of Mental Health (NIMH) 
National Institute on Alcohol Abuse and Alcoholism (NIAAA) 
National Institute on Drug Abuse (NIDA) 
Office of AIDS Research (OAR)/ NIH Office of the Director
Office of Behavioral and Social Science Research (OBSSR)/ NIH 
Office of the Director
Office of Research on Women's Health (ORWH)/ NIH Office of the Director
o        Purpose of this RFA
o        Research Objectives
o        Mechanisms of Support 
o        Funds Available
o        Eligible Institutions
o        Individuals Eligible to Become Principal Investigators
o        Special Requirements 
o        Where to Send Inquiries
o        Letter of Intent
o        Submitting an Application
o        Peer Review Process
o        Review Criteria
o        Receipt and Review Schedule
o        Award Criteria
o        Required Federal Citations
The purpose of this initiative is to 
stimulate investigator-initiated research 
on the role of stigma in health, and on 
how to intervene to 
prevent or mitigate its negative effects 
on the health and welfare of individuals, groups and 
societies world-wide.  Collaborative 
interdisciplinary applications are 
particularly encouraged.  The following Institutes 
and Centers from the U.S. Department of Health and Human 
Services (DHHS):  the Health Research Services Administration (
HRSA), the NIH including: the Fogarty International Center (FIC), National 
Center on Minority Health and Health Disparities (NCHMD), 
National Institute of Neurological Disorders and Stroke 
NINDS), National Human 
Genome Research Institute (NHGRI), National Institute of 
Alcohol Abuse and Alcoholism (NIAAA), National Institute 
of Allergy and Infectious 
Diseases (NIAID), National Institute of Dental and 
Craniofacial Research (NIDCR), National Institute of Drug 
Abuse (NIDA), National Institute of Mental Health (NIMH), 
Office of AIDS Research, 
Office of Behavioral and Social Science Research (OBSSR), 
Office of Research on Women's Health (ORWH); and the Canadian 
Institutes of Health 
Research (CIHR), seek domestic and international applications 
which address stigma-related issues, across a variety of global 
public health 
problems, among individuals and in society.  Relevant issues 
1.    How stigma and its consequences, such as discrimination 
affect health (e.g. through physical and psychological abuse, 
denial of economic 
opportunities, poor provision and seeking of health care);
2.    How stigma associated with specific health conditions 
interacts with stigma associated with individual or group 
characteristics (such as gender, race, religion, sexual 
orientation and nationality);
3.    How to prevent and mitigate the negative effects of 
stigma and 
4.    Discrimination on health and health care;
5.    Development of quantitative and qualitative methods and 
techniques to investigate, measure and analyze the extent, 
degree and effects of stigma and 
6.    The effectiveness of current and new interventions;
7.    Examination of the cultural, social, political and economic 
dimensions of stigma and its manifestations;
8.    Methods and safeguards to ensure safety of vulnerable 
research subjects.
Such research, which may range from basic to clinical and 
operational, requires expertise across a broad range of 
bio-medical, social and behavioral science fields.  The participants
 in this RFA therefore encourage interdisciplinary, domestic and 
international collaboration to build the scientific foundation of 
stigma research related to health.  Meritorious applications must 
also be relevant to the mission and interests of one or more of 
the participating Institutes or Centers.
This RFA is based on recommendations developed in conjunction with 
the NIH sponsored International Conference on Stigma and Global 
Health: Developing a Research Agenda, September 5-7, 2001, Bethesda, 
MD.  Applicants are encouraged to refer to the stigma conference website 
( for extensive information related to 
the topic of this RFA including the agenda with links to speaker 
abstracts, commissioned background papers and a video-cast of the conference.
The objectives of this initiative are to encourage research across a 
variety of scientific disciplines including the biomedical, social 
and behavioral sciences, to elucidate the etiology of stigma in 
relation to public health as well as to develop and test interventions 
to mitigate the negative effects of stigma on health outcomes.  
Studies may examine stigma and public health in domestic, international 
and cross-cultural contexts, with an emphasis on studies that are 
relevant to global health issues.  Applicants are encouraged to 
undertake interdisciplinary studies, where possible, using behavioral, 
social and biomedical science approaches.
The initiative is also designed to attract investigators across a 
broad range of biomedical and non-biomedical fields, including but 
not limited to anthropology, epidemiology, infectious and non-infectious 
diseases, geography, sociology, psychology, psychiatry, neuroscience, 
law, genetics, ethics, economics, political science, biostatistics, 
evaluation and others. 

According to a seminal work by sociologist Erving Goffman (1963 
"Stigma: Notes on the Management of Spoiled Identity") a stigma is 
an attribute that — according to prevailing societal attitudes - is 
deeply discrediting and reduces a person to one who is in some way 
tainted and can therefore be denigrated.  Individuals may internalize 
the stigmas applied to them by others.  Researchers, therefore, 
differentiate between the "felt" stigma a person perceives and "enacted" 
stigma, which refers to actions upon the individual expressed through 
various forms of discrimination. 
Stigma, when applied to health conditions, is a globally pervasive 
problem threatening psychological and physical health at the individual 
and group level.  Stigma helps to perpetuate health inequalities.  
The poor treatment of an individual because of the stigma of the 
condition itself, or of another aspect of that individual's being or 
position in society (such as gender, race, sexual orientation or 
socio-economic status), leads to poor outcomes and perpetuates other 
adverse health, social and economic consequences for the individual, 
their families and communities.  Felt stigma prevents 
individuals from coming forward for timely diagnosis and treatment and 
impairs their ability for self-care, to access care or to participate 
in research studies designed to find solutions.  Enacted stigma 
perpetuates public health problems and prevents societies from 
appropriately addressing health care issues at the community and national 
levels with the appropriate delivery, funding and support of research, 
health care services and legal and educational interventions. 
Many diseases and conditions, which persist or worsen if left untreated,
 affect a person's ability to fulfill necessary, culturally expected and 
economically productive roles in society.  The burden of their continued 
care may then fall upon families and communities lacking adequate resources 
or support.  For this reason, stigma and discrimination may greatly magnify 
the social and economic, as well as personal consequences of such diseases 
and conditions, often well beyond their prevalence in the population. 
In the case of infectious disease (for example, sexually transmitted diseases),
 stigma and discrimination related to the mode of transmission and preexisting 
attitudes towards some affected individuals can lead to fear of disclosure, 
inadequate and inappropriate treatment of all affected, and the further spread 
of a disease which might otherwise be contained.  The effects on individuals, 
families, communities and nations can be devastating, as illustrated by the 
HIV/AIDS epidemic, particularly in Sub-Saharan Africa. 
The disability and loss of productivity due to treatable mental illnesses 
and neurological disorders (such as depression, schizophrenia, epilepsy, 
movement disorders, substance abuse disorders, mental retardation and cerebral 
palsy), when inadequately treated due to stigma and discrimination, contribute 
greatly to the burden of illness on societies around the world (for more 
information please see the "World Health report 2001:  Mental Health-New 
Understanding, New Hope" and the Institute of Medicine report on "Neurological, 
Psychiatric and Developmental Disorders: meeting the Challenge 
of the Developing World", 2001, available at 
The same is true of other physical and developmental health conditions 
(including those which are disfiguring such as craniofacial disorders, and 
those that are physically disabling, such as spinal cord injury leading to 
paralysis) which if treated, mitigated or accommodated need not serve as 
barriers to full and productive lives.  Yet stigma and discrimination often 
prevent the necessary societal action to treat, research and accommodate such 
conditions.  Other public health problems, such as domestic violence and abuse, 
when ignored because of the associated stigma, perpetuate the same problems in 
individuals and across generations, along with other, often stigmatized 
health problems such as mental illnesses, 
drug and alcohol addiction and abuse. 
To have an impact, research on stigma-related health problems requires 
the participation of investigators across a broad range of biomedical 
and non-biomedical fields.  Interdisciplinary studies are needed which 
use current behavioral, social and biomedical approaches to elucidate the 
etiology of stigma in relation to health as well as develop and test 
interventions to mitigate the negative effects of stigma on health outcomes. 
 Finally, researchers must better understand the policy-making process so 
they can work to ensure that research results have an impact.
Understanding the causes, consequences and effective interventions for 
stigma-related issues and problems has the potential to significantly 
improve treatment and care particularly for public health problems of 
global importance.  In the same way that the effects of stigma magnify 
the personal and societal problems related to such diseases and disorders, 
preventing or mitigating stigma and its effects can profoundly improve the 
lives of individuals and, by extension, their families and the larger society. 
The public health community has demonstrated increasing awareness of the 
role of stigma in many diseases and disorders.  Recent conferences have 
focused on the role of stigma in mental illnesses including depression 
and schizophrenia, HIV/AIDS and epilepsy.  These conferences were convened
 by organizations including the Health and Development Networks with UNAIDS,
 the United States Substance Abuse and Mental Health Services Administration,
 the World Health Organization, and the World Psychiatric Association. 
This RFA is informed as well by the recent U.S. National Institutes of 
Health International Conference on Stigma and Global Health: Developing 
a Research Agenda (  This conference was 
convened by the Fogarty International Center of the NIH in partnership 
with various other NIH institutes and offices along with other U.S. 
agencies, and domestic and international organizations.  More than 250 
participants from 30 nations, including 23 developing countries, discussed 
stigma associated with a variety of illnesses and conditions including 
HIV/AIDS, mental health, epilepsy, physical anomalies, alcohol and drug 
abuse, physical 
and sexual abuse, genetics, race and gender. Scientists and other experts 
encompassing the health, social and behavioral 
sciences, media, law, politics and economics focused on stigma as it 
relates to global public health.  They examined both what is known about 
the causes and consequences of stigma and what can be done to prevent or 
minimize its negative effects on the health of individuals and societies.
One outcome of the conference was a set of research recommendations for 
stigma and its relationship to a variety of global public health problems.  
The recommendations include research to:
o        Further elucidate the etiology of stigma; 
o        Investigate the health consequences of stigma;
o        Develop methodology for studying stigma with respect to health;
o        Evaluate and develop new effective interventions to deal with stigma;
o        Lay the groundwork for guidelines on ethical conduct of studies on 
o        stigmatized individuals and groups who may face further negative effects,
 including physical violence or social isolation, because of their 
participation in such studies.
Research Topics
Studies of stigma are encouraged across physical and mental health 
conditions (including addictions), care settings, groups, outcomes and 
interventions, including research on the social, economic, cultural and 
political factors in both creating and intervening in stigmatization of 
health conditions. This RFA encourages interdisciplinary studies throughout 
whenever appropriate to the research question. Ethnographic and other areas 
of social science research in particular will be necessary to fully understand 
the role of stigma within a given society 
or group and to design appropriate interventions. The ways stigma is applied, 
perceived and measured in other cultures are relevant avenues of inquiry and 
ethnographic and comparative studies are encouraged alone or as components 
of other studies.
Other relevant research topics include but are not limited to the following:
1.    The role of stigma in specific public health problems, diseases or 
disorders; and its implications for issues from etiology to interventions
 and public policy; 
2.    The implications of stigma for access to care and treatment, and how 
stigma affects outcomes across health conditions;
3.    Systematic studies to determine psychological, social, economic, 
cultural and political factors that operate in the creation of stigma and
 how they link to stereotypes, discrimination and mistreatment in the 
context of health problems and health care systems; 
4.    Approaches to ensure that medical advances, which can be used to treat
 or prevent stigmatized conditions, effectively reach appropriate populations;
5.    Development of tools to study and document stigma and its impact on 
accurate determination of incidence and prevalence of health conditions;
 and to estimate the risk for over- or under-diagnosis as a result of 
stigma-related influences;
6.    Evaluation of which interventions work for stigma-related health 
problems, the characteristics of successful interventions, demonstration
 of successful interventions that can be scaled up or generalized to 
other stigmatized public health problems and/or to other populations 
and cultures;
7.    The role of stigma in provision of health care including, quality 
and extent of available treatment and care, the quality of the 
patient/health care practitioner relationship, the role of the provider's
 attitude in perpetuating stigma and the role of stigma in disclosure of 
disease status during medical visits;
8.    The role of disclosure of disease in an individuals' personal or 
professional life and its relationship to perceived stigma; 
9.    Identification of methods to minimize (or eliminate) the consequences
 of stigma/stigmatization on the recognition and diagnosis of health 
conditions and on options for treatment and/or rehabilitation;
10.Social, cultural and environmental influences on perceptions of and 
reactions to stigma/discrimination among individuals, families and communities;
 and on the resources available for coping with or ameliorating its negative
 health consequences;  
11.The interaction of social systems including gender, culture, politics, 
economics and the law in creating stigmas and the examination of the 
interplay between different kinds of stigmas as well as the combined 
impact on individuals, families, and groups;
12.The involvement of social, political, economic and legal systems in 
creating appropriate, effective and culturally sensitive interventions 
to combat stigma and the negative effects of stigma;
13.The actual and potential roles of media in creating, disseminating 
and intervening in stigma-related attitudes and actions;
14.The relationship between attributions about the causes/etiologies 
of particular diseases and disorders and the degree to which those 
with, or at risk for, the disorder are stigmatized. For example: does 
the public view a disease or disorder as more or less stigmatizing when 
it may be associated with a specific genetic predisposition; is this 
perception different for different diseases and disorders, for example 
diseases such as cancer, neurological 
and neuropsychiatric disorders such as epilepsy, movement disorders, 
schizophrenia and bipolar disorder, or conditions in which there is a 
clear behavioral component (e.g. drug abuse, obesity)?
Specific Research Areas of Interest to Stigma and Global Health RFA Sponsors:
The FIC is interested in applications on stigma and health topics relevant 
to and involving low to middle income countries of the developing world. 
Special consideration will be given to meritorious interdisciplinary 
applications from, or in collaboration with, developing country investigators.
NCMHD would like to encourage applications that have minority health or 
health disparity focus.
NIAAA is interested in supporting applications that address the 
association of stigma with the detection, prevention and treatment of 
alcohol use disorders. Of particular interest are applications that address 
alcohol abuse and addiction in populations that bear a greater burden of 
stigma (i.e. pregnant women) and alcohol related birth defects (such as 
Fetal Alcohol Syndrome). Applications that address the stigma associated 
with alcohol and other health conditions, such as HIV AIDS, will also be 
considered.  Studies on the role of stigma in the development of 
alcohol-related policies and the delivery of services are also encouraged.
NIAID encourages applications addressing the impact of stigma on control 
and treatment of infectious diseases. Of particular interest is research 
to develop and evaluate strategies to prevent or minimize the negative 
physical, cognitive, and social consequences of HIV infection, including 
the stigmatization of persons with or at risk for HIV infection. NIAID is
 particularly interested in applications with an international/developing 
country focus.
NIDA is interested in supporting applications that address the causes and 
consequences of stigma in drug abusing and addicted individuals and 
populations, including the impact on stigma on the availability and provision 
of treatment and prevention services. Studies on interventions directed at 
reducing stigma in these populations are encouraged as well.
NIDCR is interested in supporting research to identify, prevent, or 
ameliorate consequences of stigma related to socially perceived variations 
or changes in orofacial appearance or function. Such changes may, for example, 
result from orofacial injuries or from congenital craniofacial anomalies, 
such as cleft lip and palate, disfiguring infectious diseases such as noma, 
oral facial cancers or ablative cancer surgeries affecting orofacial 
structures, edentulousness, malocclusion, or other orofacial diseases/ 
NHGRI would like to encourage applications on stigma-related issues 
related to genetic disorders.
NIMH encourages research on stigma related to neuropsychiatric disorders 
and research on AIDS stigma and prevention of HIV transmission and its 
consequences including descriptive cross-sectional studies of stigma, 
longitudinal research studies and intervention studies.
NINDS encourages research on stigma related problems across the spectrum 
of neurological disorders to reduce the burden of neurological disease 
borne by every age group and segment of society all over the world. 
OAR is interested in supporting applications that address the role of 
stigma and discrimination in the HIV/AIDS pandemic.  This includes basic 
research on the causes and consequences of HIV/AIDS-associated stigma and
 discrimination, as well as intervention research to ameliorate them. 
ORWH would like to encourage applications, across the spectrum of 
possible research topics, which include in the research design scientific 
analyses aimed at delineating sex/gender differences. The results of such 
analyses are expected to be particularly important when designing and 
testing appropriate interventions to have the best possible outcomes.
The HIV/AIDS Bureau, HRSA, is interested in supporting the evaluation of 
interventions to reduce stigma as a barrier to the care and treatment of 
those living with HIV/AIDS.  Examples of potential interventions include 
training of health care providers, community involvement in HIV program 
planning, and the inclusion of people living with HIV/AIDS in program 
planning and as staff or volunteers in care and support programs.  
Programs that tie decreases in stigma to increased access to care and 
improved quality of care are of particular interest.

The Institute of Neurosciences, Mental Health and Addiction  (INMHA) of 
the Canadian Institutes of Health Research (CIHR) is interested in 
supporting applications from Canadians or, in collaboration with the Canadian
 International Development Research Center (IDRC), in co-sponsoring proposals
 originating in and responding to priorities of developing countries and with
 a Canadian component. Eligible applications for CIHR/INMHA include those 
dealing with research on stigma related to neurological disorders, mental 
illnesses and addictions which are aimed at finding innovative, effective 
and evidence-based means to reduce discrimination, improve access to 
services and to raise public awareness through education.
Contact the representatives of the participating Agencies, Institutes or 
Centers (ICs) listed in the  "Where to Send Inquiries" section of this RFA 
or visit individual Agency and IC websites for more information about topics
 of interest to each. Additional research questions and other information 
of specific interest to individual participating Agencies and ICs in the 
of this RFA can be found at:
This RFA will use the National Institutes of Health (NIH) research 
project grant (R01) and the developmental/exploratory grant (R21) award 
mechanisms.  Note that the R21 mechanism is specifically intended to 
support innovative ideas where preliminary data as evidence of feasibility 
are sparse or do not exist.  R21 grants are not intended for large-scale 
undertakings or to support or supplement ongoing research.  Rather, 
R21-supported projects are intended to serve as a basis for planning and 
strengthening future research project grant applications (R01).
This RFA also uses just-in-time concepts and the modular grant format 
(see Specifically, 
if you are submitting an application with direct costs in each year of 
$250,000 or less, use the modular format (modules of $25,000).  Otherwise
 follow the instructions for non-modular research grant applications. 
Applications submitted by foreign institutions can request facilities and 
administrative (F&A) costs up to a maximum of eight percent.  Please see 
the web site
 for more information on allowable F&A costs for foreign grants and domestic 
grants with foreign components.
This RFA is issued for fiscal year (FY) 2003 and the anticipated award start
 date is July 2003.  Applications submitted in response to this RFA may 
have a project period of up to five years for R01 and up to three years 
for R21 grant applications.  As an applicant you will be solely responsible 
for planning, directing, and executing the proposed project.
At this time, it is not known if this RFA will be reissued. Any future 
unsolicited competing continuation applications based on this project may 
compete with all NIH investigator-initiated applications and be reviewed 
according to the customary peer review procedures. 
The participating ICs intend to commit approximately $2.5 million in FY 
2003 to fund up to 12 new competitive grants in response to this RFA. 
R21 grant applicants may request a project period of up to three years 
with a total direct cost of $100,000 per year. 
R01 grant applicants may request a project period of up to five years. An 
applicant may request a budget up to 
1)    $500,000 direct costs per year for applications in which comparative 
or intervention studies at two or more international sites are planned, 
and which involve an international team of investigators.  No one site 
may be allocated more that half the budget.
2)    $200,000 direct costs per year for all other projects (i.e. those that
 will take place only in a single country, do not propose comparative or 
intervention studies, do not involve an international collaboration). 
Because the nature and scope of the proposed research will vary from 
application to application, it is anticipated that the size and duration 
of each award will also vary, with multidisciplinary collaborative, 
international applications requiring more funding and time. Although the 
financial plans of the IC(s) provide support for this program, awards pursuant
 to this RFA are contingent upon the availability of funds and the receipt 
of a sufficient number of meritorious applications. Each award will be 
administered by one of the participating NIH ICs or other participating 
agencies although several may participate in funding of any given application.
The Canadian Institute for Health Research (CIHR) along with the Canadian 
International Development Research Centre (IDRC) will consider meritorious 
applications, relevant to their missions, from Canadian applicant institutions.
  CIHR will make the award of grants for meritorious applications of interest 
to them.  Applicants who wish to have their projects considered for funding by
 CIHR should include with their application a letter stating that their 
application and summary statement may be shared with CIHR 
and IDRC.
You may submit (an) application(s) if your institution is in one of the 
following categories:
o        For-profit or non-profit organizations 
o        Public or private institutions, such as universities, colleges, 
hospitals, and laboratories 
o        Units of State and local governments
o        Agencies of the Federal government 
o        Domestic or foreign institutions or organizations
o        Faith-based organizations 
Any individual with the skills, knowledge, and resources necessary to 
carry out the proposed research is invited to work with their institution 
to develop an application for support.  Individuals from underrepresented 
racial and ethnic groups as well as individuals with disabilities are always
 encouraged to apply for NIH programs.   
Two meetings of grantees of these awards will be held in the Washington, 
D.C. area (one in the second year and one in the fourth year of the grant 
period) to share information and discuss new insights on stigma and health,
 in particular, stigma intervention strategies. For these meetings, funds 
should be budgeted for travel by the PI and/or other relevant individuals 
with significant day-to-day involvement in the activities performed under 
this award.
We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management
o GENERAL INQUIRIES regarding the scope and content of this Request for 
Applications should be directed to:
Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-435-6031
Fax:  301-402-0779
o Direct your questions about SCIENTIFIC/RESEARCH ISSUES to the contacts 
below (additional specific research questions of interest to participating 
ICs can be found in the "Research Topics" section of this RFA and at 
Astrid Eberhart
Institute Liaison
Institute of Neurosciences, Mental Health and Addiction
Canadian Institutes of Health Research
410 Laurier Avenue W., 9th Floor
Address Locator 4209A
Ottawa, ON  K1A 0W9
Telephone:  613-941-4643
Fax:  613-941-1040
Laura Cheever, M.D., Sc.M.
Chief, HIV Education Branch
Health Resources and Services Administration
Parklawn Building, Room 7-29
5600 Fishers Lane 
Rockville, MD  20857
Telephone:  301-443-3067
Fax:  301-443-9887
Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892
Telephone:  301-435-6031
Fax:  301-402-0779
Jean E. McEwen, J.D., Ph.D.
Program Director
Ethical, Legal, and Social Implications Program
National Human Genome Research Institute
National Institutes of Health
Building 31, Room B2B07
31 Center Drive, MSC 4997
Bethesda, MD  20892-2033
Telephone:  301-402-4997
Fax:  301-402-1950
Margaret M. Murray, M.S.W.
Chief, International and Health Education Programs Branch
National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
6000 Executive Boulevard, Suite 302
Rockville, MD 20852
Telephone:  301-443-2594
Rodney Hoff, D.Sc., MPH 
Vaccine and Prevention Research Program 
Division of AIDS, NIAID/NIH 
6700B Rockledge, Room 4157, MSC 7620
Bethesda, MD 20892-7620 
Telephone:  301 496 6179 
Patricia S. Bryant, Ph.D.
Director, Behavioral and Social Science Research
Division of Population and Health Promotion Sciences
National Institute of Dental and Craniofacial Research
National Institutes of Health
Building 45, Room 4AN24E, MSC 6402
Bethesda, MD 20892-6402
Telephone:  301-594-2095
Fax:  301-480-8318
Minda R. Lynch, Ph.D.
Branch Chief 
Behavioral and Cognitive Sciences Research Branch
Division of Neuroscience and Behavioral Research
National Institute on Drug Abuse
National Institutes of Health
6001 Executive Boulevard, Room 4282, MSC 9555
Bethesda, MD  20892
Telephone:  301-435-1322
Fax:  301-594-6043
Leslie C. Cooper, Ph.D., M.P.H.,B.S.N.,R.N.
Research Program Director for the Epidemiology, Etiology and 
Consequences of 
Drug Abuse in Special Populations and Health Disparities. 
Nurse Epidemiologist
6001 Executive Boulevard, Room 5167, MSV 9589
Bethesda, MD 20892-9589
Telephone:  301-402-1906
Fax:  301-480-2543 
Emeline Otey, Ph.D.
Division of Mental Disorders, Behavioral Research and AIDS 
National Institute of Mental Health 
6001 Executive Boulevard, Room 6186, MSC 9625 
Bethesda, MD  20892-9625 
Telephone:  301-443-1636 
Fax:  301-443-4611 
Christopher M. Gordon, Ph.D.
Division of Mental Disorders, Behavioral Research, and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6204, MSC 9619
Bethesda, MD  20892-9619
Telephone:  301-443-1613
Margaret P. Jacobs
Program Director, Epilepsy Research
National Institute of Neurological Disorders and Stroke, NIH
Neuroscience Center
6001 Executive Boulevard, Room 2138, MSC 9523
Bethesda, MD  20892-9523   
Telephone:  301-496-1917
Fax:  301-480-2424
Paul A. Gaist, Ph.D., M.P.H.
Health Scientist Administrator
Office of AIDS Research
Office of the Director
National Institutes of Health
Building 31, Room 4C06
31 Center Drive
Bethesda,MD  20892
Telephone:  301-402-3555
Fax:  301-496-4843
Joyce Rudick
Director, Programs and Management
Building 1, Room 201
9000 Rockville Pike, MSC 0161
Bethesda, MD 20892-0161
Telephone:  301-402-1770
Fax:  301-402-1798
o Direct your questions about peer review issues to:
Mariela C. Shirley, Ph.D.
Risk, Prevention, and Health Behavior IRG 
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1102, MSC 7848
Bethesda, MD 20892-7848
Bethesda, MD  20817 (For express/courier service)
Telephone:  301-435-3554
Fax:  301-480-3962
o Direct your questions about financial or grants management 
matters to:
Bruce Butrum
Grants Management Officer
Grants Office
Fogarty International Center
Building 31, Room B2C29
31 Center Drive,MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-496-1670
Fax:  301-402-0779
H. George Hausch, Ph.D.
Division of Extramural Activities
National Institute of Dental and Craniofacial Research
National Institutes of Health
Building 45, Room 4AN-44K, MSC 6402
Bethesda, MD 20892-6402
Telephone:  301-594-2904
Fax:  301-480-8303
Prospective applicants are asked to submit a letter of intent that 
includes the following information:
o Descriptive title of the proposed research
o Name, address, and telephone number, of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 
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 IC staff to estimate the potential review workload 
and plan the review.
The letter of intent is to be sent by the date listed at the beginning 
of this document.  The letter of intent should be sent to:
Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-435-6031
Fax:  301-402-0779
Applications must be prepared using the PHS 398 research grant 
application instructions and forms (rev. 5/2001).  The PHS 398 is 
available at in an 
interactive format.  For further assistance contact GrantsInfo, 
Telephone (301) 435-0714, 
Description section:  If a country other than the home country of the 
applicant institution is involved in the application, please include the 
name of the other country or countries in your description.
Canadian Applicants:  Applicants who wish to have their projects considered 
for funding by CIHR and IDRC must include with their application a letter 
stating that their application and summary statement should be shared with 
R21 applications:  limit of 20 pages for the Research Plan (sections a-d).
requesting up to $250,000 per year in direct costs must be submitted in a 
modular grant format.  The modular grant format simplifies the preparation 
of the budget in these applications by limiting the level of budgetary 
detail.  Applicants request direct costs in $25,000 modules.  Section C 
of the research grant application instructions for the PHS 398 (rev. 5/2001)
 at includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at
USING THE RFA LABEL:  The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  Failure to use this label 
could result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA title 
and number must be typed on line 2 of the face page of the application form 
and the YES box must be marked.  The RFA label is also available at:
SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten original of 
the application, including the Checklist, and four signed photocopies, in 
one package to:
Center For Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (For express/courier service)
At the time of submission, one additional copy of the application must be 
sent to:
Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Phone:  301-435-6031
Fax:  301-402-0779
APPLICATION PROCESSING:  Applications must be received by the application 
receipt date listed in the heading of this RFA.  If an application is 
received after that date, it will be returned to the applicant without review.
The Center for Scientific Review (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 Introduction addressing the previous critique.
Upon receipt, applications will be reviewed for completeness by the CSR and 
responsiveness by the participating Institutes and Centers. Incomplete 
applications will be returned to the applicant without further consideration. 
If the application is not responsive to the RFA, CSR staff may contact the 
applicant to determine whether to return the application to the applicant or 
submit it for review in competition with unsolicited applications at the next
 appropriate NIH review cycle.
Applications that are complete and responsive to the RFA will be evaluated 
for scientific and technical merit by an appropriate peer review group 
convened by the CSR in accordance with the review criteria stated below.  
As part of the initial merit review, all applications will:
o Receive a written critique
o May undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Council of the 
relevant participating IC or Board. 
The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  
In the written comments, reviewers will be asked to discuss the following 
aspects of your application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these 
o Significance 
o Approach 
o Innovation
o Investigator
o Environment
The scientific review group will address and consider each of these criteria
 in assigning your application's overall score, weighting them as appropriate
 for each application.  Your application does not need to be strong in all 
categories to be judged likely to have major scientific impact and thus 
deserve a high priority score.  For example, you may propose to carry out 
important work that by its nature is not innovative but is essential to move 
a field forward.
(1) SIGNIFICANCE:  Does your study address an important problem related to 
stigma and health? If the aims of your application are achieved, how do they 
advance scientific knowledge?  What will be the effect of these studies on the
 concepts or methods that drive this field?
(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative
 tactics? Do your project use multidisciplinary tools, techniques and 
expertise to address stigma and health at various levels?
(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?
(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out
 this work?  Is the work proposed appropriate to your experience level as 
the principal investigator and to that of other researchers (if any)?
(5) ENVIRONMENT:  Does the scientific environment in which your work will 
be done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific environment 
or employ useful collaborative arrangements?  Is there evidence of 
institutional support?
ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:
Innovation of the project and potential significance of the proposed 
research will be the major considerations in the evaluation of the R21 
exploratory grant mechanism.  Because the R21 is designed to support 
innovative ideas, preliminary data as evidence of feasibility of the 
project are not required.  However, the applicant is also responsible for 
presenting the background literature that provides some basis for the 
approach and for developing a rigorous research plan.  Relevant pilot data 
should be cited when available. 
o PROTECTIONS:  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.
o INCLUSION:  The adequacy of plans to include subjects from both genders, 
all racial and ethnic groups (and subgroups), and children as appropriate 
for the scientific goals of the research.  Plans for the recruitment and 
retention of subjects will also be evaluated. (See Inclusion Criteria 
included in the section on Federal Citations, below)
o DATA SHARING:  The adequacy of the proposed plan to share data. 
o BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.
Letter of Intent Receipt Date:  October 14, 2002
Application Receipt Date:  November 14, 2002
Peer Review Date:  February 2003
Council Review:  May 2003
Earliest Anticipated Start Date:  July 1, 2003
Award criteria that will be used to make award decisions include:
o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
Research components involving Phase I and II clinical trials must include 
provisions for assessment of patient eligibility and status, rigorous data 
management, quality assurance, and auditing procedures.  In addition, it is 
NIH policy that all clinical trials require data and safety monitoring, with 
the method and degree of monitoring being commensurate with the risks (NIH 
Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, 
June 12, 1998:  
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating 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 Public Law 103-43).
All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants 
and Contracts on October 9, 2001 (
files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are 
available at
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new 
OMB standards; clarification of language governing NIH-defined Phase III 
clinical trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must 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 b) 
investigators must report annual accrual and progress in conducting analyses, 
as appropriate, by sex/gender and/or racial/ethnic group differences.
The NIH maintains a policy 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 and ethical reasons not to include 
them. This policy applies to all initial (Type 1) applications submitted for
 receipt dates after October 1, 1998.
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 is available at 
policy requires education on the protection of human subject participants 
for all investigators submitting NIH proposals for research involving human 
subjects.  You will find this policy announcement in the NIH Guide for Grants 
and Contracts Announcement, dated June 5, 2000, at
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information 
Act (FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at
Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
istribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the application.
 In addition, applicants should think about how to structure informed consent 
statements and other human subjects procedures given the potential for wider 
use of data collected under this award.
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.  Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.
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 is related to
 one or more of the priority areas. Potential applicants may obtain 
a copy of "Healthy People 2010" at
AUTHORITY AND REGULATIONS:  This program is described in the Catalog of Federal
 Domestic Assistance No. 93.989.  Awards are made under authorization of sections
 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and 
administered under NIH grants policies and Federal Regulations 42 CFR 52 and 45 
CFR Parts 74 and 92.  This program is not subject to the intergovernmental review 
requirements of Executive Order 12372 or Health Systems Agency review. 
The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of
 the American people.