CENTERS FOR RESEARCH TO REDUCE ORAL HEALTH DISPARITIES

Release Date:  September 30, 1999

RFA:  DE-99-003 May 3, 2007  - This RFA has been reissued as (RFA-DE-08-008).

National Institute of Dental and Craniofacial Research
Health Resources and Services Administration
National Institute of Child Health and Human Development
National Institute of Nursing Research
Centers for Diseases Control and Prevention
Office of Research on Minority Health
Office of Behavioral and Social Science Research
Office of Research on Women"s Health

Letter of Intent Receipt Date:  July 17, 2000
Application Receipt Date:  November 15, 2000

PURPOSE

The National Institute of Dental and Craniofacial Research (NIDCR) along with
the Health Resources and Services Administration (HRSA), the National
Institute of Child Health and Human Development (NICHD), the National
Institute of Nursing Research (NINR), the Centers for Disease Control and
Prevention (CDC), the Office of Behavioral and Social Science Research
(OBSSR), the Office of Research on Minority Health (ORMH), and the Office of
Research on Women"s Health (ORWH) invites applications for research designed
to lead to a reduction in health disparities among the peoples of the United
States by focussing on craniofacial, oral and dental diseases, disorders and
health.  This Request for Applications (RFA) represents the natural evolution
of philosophy in the previously funded Regional Research Centers for Minority
Oral Health (RRCMOH) initiative.  Receipt of an RRCMOH grant, however, is not
a prerequisite for submission of an application in response to this RFA.

The overall objectives of the Centers for Research to Reduce Oral Health
Disparities (CRROHD) initiative are to support research that will lead to an
understanding of the factors associated with health disparities as well as to
support the development, testing and evaluation of interventions designed to
reduce health disparities with a particular interest in oral, dental and
craniofacial diseases and disorders. It is expected that each center will be a
training and mentoring resource for developing and strengthening the
biomedical, clinical and behavioral health research capacity of the nation by
expanding research opportunities for scientists in underrepresented groups
within the scientific workforce through required collaborations with minority
institutions as well as through other career development activities.

Although the overall focus of the initiative is on reducing health disparities
in children and their caregivers, research proposed by individual centers may
fit within the scope of the initiative by focussing on one aspect of issue
(e.g., examining factors contributing to or reducing the health disparities of
caregivers alone, assessing oral health status of children in specific
SES/cultural/regional/community groups, collecting data and/or developing
interventions that address a specific health disparity in a defined group) or
they may address the full range of research possibilities (e.g., role of oral
health of mothers and/or other family members in the health of neonates and
children, access to health care issues as they related to the craniofacial,
oral or dental health of children and their caregivers).

The focus of this new center initiative is on reducing health disparities
through basic, translational, clinical, patient-oriented health services and
community-based research.  It is envisioned that realization of this central
focus will be accomplished through the development of knowledge that will lead
to an understanding of biological, behavioral, psychological, anthropological,
sociological and economic causes of health disparities in the United States. 
It is also envisioned that the new knowledge will lead to the design and
testing of interventions that rely on and take advantage of the cultural
competencies involved in the health of members of various groups.

A major hallmark of the initiative is national research and training networks. 
These may be fostered by increased collaborations across the health
professions (e.g., dentistry, medicine, nursing, pharmacy, behavioral and
social sciences, public health) both within and between institutions as well
as between the health professions and social services (e.g., State and Local
health and health financing agencies) directed at health promotion.  Finally,
the initiative is inclusive with respect to populations of interest in that it
spans the racially, ethnically and culturally diverse populations of our
nation including populations of recent immigrants, individuals at all
socioeconomic status (SES) levels, those from both rural and urban settings,
and individuals who are medically challenged or compromised.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This RFA, Centers for Research to Reduce
Oral Health Disparities, is related to one or more of the priority areas.
Potential applicants may obtain a copy of "Healthy People 2000" at
http://odphp.osophs.dhhs.gov/pubs/hp2000.

ELIGIBILITY REQUIREMENTS

Research grant applications may be submitted by domestic for-profit and non-
profit organizations, public and private, such as academic health centers,
dental schools, universities, colleges, laboratories, units of State and Local
governments, and eligible agencies of the Federal Government. It is expected
that the applicant institution will have received support for research from
NIH or other federal agencies.

Although currently funded RRCMOH institutions are encouraged to apply for a
CRROHD, prior receipt of a RRCMOH grant is not a prerequisite for applying for
or receiving grant under the terms of this RFA.  Applications from foreign
institutions are not eligible but collaborations between domestic and foreign
institutions may be scientifically necessary and justifiable. Applications
from minority individuals, women, and persons with disabilities as principal
investigators are strongly encouraged.

To be responsive to this RFA, an applicant must propose collaborative
affiliations with other entities.  The collaboration can be with entities from
within the parent institution as well as with other institutions and should be
for the purpose of facilitating and addressing the scientific objectives of
the proposed center.  Collaborations may encompass
colleges/schools/departments representing the entire spectrum of the health
professions (e.g., dentistry, medicine, nursing, pharmacy, veterinary
sciences, behavioral and social sciences) or academic institutions and State
and Local health and health financing agencies (e.g., state Medicaid agencies
and Children"s Health Insurance Programs). To be eligible for this initiative,
each center is required to involve a partnership with one or more minority
institutions (e.g., Historically Black Colleges and Universities, Hispanic
serving institutions, Tribal Colleges and Universities).  The applicant may be
either a minority institution or a non-minority institution.  Additional
details about this aspect of the initiative are contained in the section
titled "Center Characteristics."

Regional proximity of the affiliated institutions is not required but, for a
variety of reasons, may be an asset.  However, such an arrangement may not be
possible.  In those instances, applicants are urged to provide compelling
evidence of procedures and/or processes that will be used to overcome any
potential problems associated with the geographical separation.

MECHANISM OF SUPPORT

The mechanism of support utilized will be the Specialized Center (P50)
mechanism.  Responsibility for the planning, direction, and execution of the
proposed project will be solely that of the applicant and collaborating
institutions.  However, consultation with NIDCR staff will be expected in the
form of periodic site visits and annual meetings of center directors. 
Although this RFA is a one-time solicitation for new and competing renewal
awards, depending on the availability of funds, it is expected that a
subsequent competition among funded CRROHD centers will be held.  The total
project period for an application submitted in response to this RFA may not
exceed seven years and it is anticipated that the subsequent competition will
be for funding for a similar period. The earliest possible date for funding is
August 2001.

FUNDS AVAILABLE

Up to five awards will be made if a sufficient number of highly meritorious
applications are received and sufficient funds are available.  Additional
centers may be funded depending on the availability of funds and highly
meritorious applications.  Each award may not exceed $1.5 million total costs
(i.e., direct plus indirect costs including those indirect costs associated
with consortia and/or contracts) for research projects, pilot projects and
cores in the first year. Increases in costs for subsequent years may not
exceed three percent.  All applicants must include costs associated with
annual meetings in Bethesda of center directors and their key scientific
personnel.  In addition, centers that propose a prospective, randomized
clinical trial must include funds for annual meetings of an independent Data
and Safety Monitoring Board (DSMB) to provide oversight and review of patient
safety and progress of the trial.  Information about the structure and
function of the DSMB is available from NIDCR staff listed under INQUIRIES or
from the NIDCR home page (http://www.nidcr.nih.gov). It is strongly urged that
additional funds be sought from other federal agencies as well as from
institutional, corporate and foundation sources to augment support from the
NIDCR.  Award of grants pursuant to this RFA is contingent upon the
availability of funds.

RESEARCH OBJECTIVES

Background

Dental and craniofacial diseases and disorders are among the most common
health problems affecting the people of the United States.  The burden imposed
by a variety of dental and craniofacial diseases and disorders range from
birth defects such as cleft lip and palate, which occurs in every 1 in 525 to
714 live births, to injuries to the head and face, resulting in nearly 20
million emergency room visits per year, to devastating head and neck cancers,
accounting for 8000 deaths and over 30,000 new cases per year.  The treatment
of over 1.2 million cancer patients each year can lead to complications such
as painful mouth ulcers, mucositis, rampant dental caries, fungal infections,
impaired taste and loss of function of the salivary glands.  Oral infections
still remain common in our populations.  Dental caries is experienced by 45%
of elementary aged school children and 94% of adults have experienced this
infection at some point in life.  Periodontal infections occur in 90% of
individuals older than 13 years and may be associated with other systemic
diseases or conditions such as diabetes, cardiovascular disease, respiratory
infections, and pre-term/low birth weight babies. Orofacial pain is likely to
have been experienced by over 20% of adults in the past six months, is a major
component of temporomandibular joint diseases (TMD) for at least 6% of adults,
and is a major component of Bell"s palsy, trigeminal neuralgia and
fibromyalgia.  Salivary gland dysfunction in the form of Sjogren"s syndrome
affects between 1 and 4 million Americans while over 30,000 individuals who
have cystic fibrosis are also at higher risk for concomitant salivary gland
dysfunction. Further, over 500 prescription drugs have xerostomic (dry mouth)
side effects, increasing the risk for both bacterial and fungal oral
infections as well as other oral conditions.  Oral candidiasis is commonly
found in HIV-infected patients.

Many of these craniofacial, oral and dental diseases and disorders have a
disproportionately higher burden on particular population subgroups. 
Addressing disparities in craniofacial, oral and dental health among the
diverse populations of the United States continues to be a major focus of the
research supported by the NIDCR.  Strategic Initiative I (Research
Opportunities) of the strategic plan, "SHAPING THE FUTURE"
(http://www.nidcr.nih.gov), focuses on, among other areas, the importance of
oral health promotion and disease prevention, behavioral research, and
epidemiological research as areas of importance to the Institute.  Strategic
Initiative III (Health Promotion) calls for research that addresses the health
needs of all segments of the United States population.  Furthermore, Strategic
Initiative II (Research Capacity) of the current NIDCR strategic plan states
that, in developing the human and technological resources needed to realize
the full potential of scientific opportunities, one of the primary objectives
of the Institute is to facilitate the participation of women, ethnic and
racial minorities, and individuals with disabilities in research.  As such,
the current initiative continues a focus on the development of collaborations
that can strengthen the capacity of institutions to plan and conduct
scientifically meritorious research and to engage in appropriate research
training and career development of individuals associated with these
institutions.

It is still evident that in the United States the burden of disease falls
disproportionately among racial and ethnic minorities, individuals from lower
socioeconomic classes, women and children. Nearly 50 million Americans suffer
from disproportionately high incidence and prevalence of a wide range of
diseases and disorders. Among these are inherited and acquired birth defects,
craniofacial/oral trauma, infectious diseases, severe malocclusion and
orthognathic conditions, oral complications of systemic diseases, oral and
pharyngeal cancer, temporomandibular diseases, chronic facial pain and other
diseases and conditions of the oral and craniofacial complex and the rest of
the body.  A recent report issued by the Department of Health and Human
Services titled "Racial and Ethnic Disparities in Health: Response to the
President"s Initiative on Race" recognizes the need for new knowledge about
the determinants of disease and effective interventions for prevention and
treatment to eliminate health disparities.  The report targets six goals aimed
at addressing specific health disparities including infant mortality, cancer,
cardiovascular disease, diabetes, HIV/AIDS, and immunization.

As documented in the publication, "Women of Color Health Data Book," women and
men of color are disproportionately represented among the nearly 41 million
Americans without health insurance and it is known that there is uneven access
to health care and heath care resources among the diverse populations of the
United States (NIH Publication 98-4247, 1998, p.68).  Similar documentation,
particularly that pertaining to the health of women and children, is available
through the home page for the Public Health Service Office of Women"s Health
(http://www.4women.gov/owh/index.htm).  While it is estimated that 14% of all
whites did not have coverage in 1995, the same was true for 21% of African
Americans and 33% of Hispanics (NIH Publication 98-4247, 1998, p.68).  These
percentages increase for all groups for individuals of lower socioeconomic
status.  Furthermore, African Americans (20%) than whites (13%) reported that
they used hospital emergency departments as their source of primary health
care.  Conversely, 58% percent of whites and 48% percent of African Americans
make their usual contact with physicians in a non-hospital setting such as the
typical office (NIH Publication 98-4247, 1998, p. 70). The impact of these
differences on health is profound and may account for many of the increased
risk factors for disease among underserved populations.

For example, it has been reported (NIH Publication 98-4247, p. 73-76) that
white women exhibit among the highest incidence of all forms of cancer (i.e.,
346/100,000) yet mortality rates are lower for them (i.e., 140/100,000) than
for Alaskan Natives (i.e., 179/100,000), Native Hawaiians (i.e., 168/100,000),
and African Americans (i.e., 168/100,000).  A similar picture emerges when
comparisons are made for specific forms of cancer, including breast and
cervical cancer.  It has been speculated that this pattern can be accounted
for by several interrelated factors including later detection of disease,
unequal access to health care resulting from lower access to health insurance,
geographically more remote health care facilities for women of color than
white women, and problems associated with the reliability of surveys on low
SES individuals (e.g., underreporting, misidentification of race or ethnicity,
misidentification of causes of mortality).

Other factors involved in the causes of health disparities are varied and
complex (Haynes & Smedley, 1999, Williams & Collins, 1995).  Traditional
variables have included race, ethnicity or culture, socioeconomic status
(SES), gender/sex and age.  Yet it appears that none of these alone can
account for all of the documented differences.  Williams and Collins (1995)
note that even socioeconomic status as a measure of class leaves much of the
variability in health status unexplained.  They note that research on the
determinants of health indicates that stress in family home and work
environments, health practices, social support systems, access to health care,
and attitudes toward health are all important determinants of health status. 
Another example, highlighted in a chapter outlining a research agenda on
women"s oral health in a publication from the Office of Research on Women"s
Health, NIH points to the potential role of gender/sex in health disparities
and the need for much research involving women (Redford, Jeffcoat & Silverton,
1999).  In many instances a woman is not only the major caregiver of children
but she is also the source of much health information for others in the family
group.  This coupled with the fact that there is still much to be learned
about factors influencing women"s oral health, points to a need for research
involving this very important segment of our population.  As noted by Anderson
(1998) discovering the interrelationships among the multitude of variables
that affect health and disease, their relationship(s) to more traditional
variables, and, ultimately, the relationship between all of these factors and
the underlying biological and physiological processes involved in health and
disease is critical in our understanding of disease and hence for
understanding the bases for health disparities as well as providing a pathway
to preventing and reducing them.

Research from within the field of oral health illustrates some of the
complexities that are emerging from research on health disparities.  Race and
ethnicity appear to influence health beliefs and perceptions of health.
Beliefs and perceptions, in turn, can determine when or if an individual seeks
treatment (Kuthy, Odom, Salsberry, Nickel, & Polivka, 1998, Kwan, Williams &
Duggal, 1996, Gift, Atchison & Drury, 1998).  Perceptions of oral health,
particularly of those conditions which an individual believes to be "normal",
can be influenced by age, race, ethnicity, education, general health, and
utilization of the health care system (Atchison & Gift, 1997).  While it is
known that the lack of health care providers from with a given racial/ethnic
group influences health status in persons from within those groups obtaining
timely and appropriate health care (Grumbach, Coffman, Young, Vranizan &
Blick, 1998) little is known about similar influences on craniofacial, oral
and dental diseases and disorders.  Similarly, while it is known functional
health literacy influences health status among the elderly (Gazmararian,
Baker, Williams, Parker, Scott, Green, Fehrenbach, Ren, & Koplan, 1999), the
low-income elderly (Weiss, Reed & Kligman, 1995) as well as individuals of
various racial/ethnic groups (Williams, Parker, Baker, Parikh, Pitkin, Coates
& Nurss, 1995) little is known about the influence of these factors on
craniofacial, oral and dental diseases and disorders.

According to the draft version of "Healthy People 2010," the level of
untreated dental caries among racial and ethnic minority groups is greater
than the national average, smaller proportions of minority and poor children
have dental sealants, African Americans have a poorer five-year survival rate
for oral and pharyngeal cancer than whites (31% vs. 55%), and almost nine
percent of low SES adults have lost all their teeth compared with five percent
in the total adult population.  Forty-two percent of the poor elderly were
edentulous in 1993 compared with 36% of all persons 65 years and older.  The
proportion of the U.S. population that makes at least an annual dental visit
as well as the average number of dental visits made per year vary
significantly by age, race, and family income.  The proportion of the
population with an annual dental visit is highest among children between 5 and
17 years and lowest among children between 2 and 4 years. About 57% of the
total U.S. population over 2 years report a dental visit in the past year, but
fewer than one-half of those over 65 years have made such a visit. Only 41% of
those with annual family incomes below $10,000 report a dental visit in the
past year compared with 73% with family incomes above $35,000.

As noted in the draft version of "Healthy People 2010," dental insurance
coverage is a strong predictor of the use of dental services. Because dental
insurance is typically employment-based, persons who do not work or who work
only part time or who are self-employed are less likely to be insured and
hence less likely to use dental services than full-time employees.  The
National Association of Dental Plans estimates that 45% of the 1995 U.S.
population had dental insurance and Medicaid coverage for adults varies from
state to state. Lower proportions of low SES children and members of racial
and ethnic minority groups have private dental insurance than the national
average. Although public sector programs such as Medicaid, and more recently
Children"s Health Insurance Program (CHIP), hold great promise for improving
the oral health of many low income and minority children, access barriers may
temper that potential. Low SES children make 37% fewer visits of dental
offices than do those from higher SES groups and children from families below
200 percent of the Federal Poverty Level have substantially more unmet dental
treatment needs than children from families with higher income levels (Vargas,
et. al, 1998).  Similarly, lower proportions of members of racial and ethnic
minorities and low SES adults than the general population have made dental
visits in the past year.  Visits to dentists by elderly African Americans
(22%) and all poor elderly (26%) during the past year are approximately one-
half of the national average for the elderly.  Only 15% of the elderly have
any private dental insurance and Medicare does not provide reimbursement for
routine dental services.

The relatively poor health status of underserved populations may also reflect
the lack of research on these individuals, particularly with respect to
craniofacial, oral and dental diseases and disorders.  This may, in turn, be a
reflection of the relative scarcity of culturally and economically sensitive,
well-trained scientists engaging in craniofacial, oral and dental health
research. Limited opportunities for individuals from various racial/ethnic
groups to receive training and mentoring in research activities not only
because of a lack of research resources at their home institutions but also
because of a lack of opportunities to engage in research play a large role in
the shortage of culturally sensitive and competent scientists.  While the
NIDCR continues to encourage the participation of minority scientists in
health research through various training programs as well as through the
Research Supplements for Underrepresented Minorities initiative, additional
opportunities are also needed. Thus, in addition to the principal aim of this
initiative to support research to reduce health disparities, a complementary
aim is to enhance the future funding opportunities for scientists at non-
research intensive institutions by pairing them, through collaborative
affiliations, with individuals at research intensive institutions.  It is
anticipated that accomplishment of this aim will not only enhance the research
careers of individuals underrepresented in the scientific workforce but it
will also attract qualified underrepresented undergraduate and graduate
students to careers related to reducing health disparities, especially those
related to craniofacial, oral and dental diseases and disorders.

Center Characteristics

The Centers for Research to Reduce Oral Health Disparities are viewed as a
national and all encompassing resource. Even though funds provided through
this RFA are restricted to the support of research activities, it is expected
that each application will include specific plans for developing training and
career development opportunities. Each center is required to involve a
partnership with one or more minority institutions (e.g., Historically Black
Colleges and Universities, Hispanic serving institutions, Tribal Colleges and
Universities).  The applicant may be either the minority or non-minority
institution.  An application that does not include such a collaboration will
not be considered for funding and be returned to the applicant unreviewed.

For the purposes of this RFA a minority institution is defined as: (a) 
providing education or training for individuals from underrepresented groups 
within the craniofacial, oral and dental scientific workforce (i.e., an 
educational, health care, academic health center, medical school, dental 
school, nursing school, public health school or research institution whose 
student enrollment and faculty consists of 50 percent or more individuals 
from underrepresented groups such as American Indians and Alaskan Natives, 
African Americans, Hispanics, and Asian Americans/Pacific Islanders), and/or 
(b) serving large underserved populations (i.e., an educational, health care, 
academic health center, medical school, dental school, nursing school, public 
health school or research institution whose patient population consists of 50 
percent or more of individuals from groups traditionally considered to be 
under served with respect to their craniofacial, oral and dental health 
needs).

Each center will represent a consortium consisting of two or more institutions
as well as collaborations between departments, divisions and schools within a
single institution. Examples of components of research and institutional
consortia include:

o  inter-institutional networks such as partnerships among colleges and
universities, State and Local health financing agencies, State departments of
education, HRSA Community/Migrant Health Centers, CDC Prevention Research
Centers, tribal urban and direct Indian Health Service clinics and hospitals,
and academic health centers,

o  inter-disciplinary health professions networks such as partnerships among
dental, medical, nursing, pharmacy, and public health colleges and schools,
and

o  multi-disciplinary networks such as partnerships among basic and social
science programs and clinical and epidemiologic science programs.

The grantee institution must be an educational, academic health center,
medical school, dental school, nursing school, and public health school or
research institution.

Institutions comprising the consortia should be selected to facilitate the
attainment of the scientific objectives of the center and may include
community health centers, State and Local health and health financing agencies
(e.g., CHIP, Medicaid), HMOs or PPOs, nursing homes or other government funded
organizations (e.g., HRSA Community/Migrant Health Centers, CDC Prevention
Research Centers, tribal urban and direct Indian Health Service clinics and
hospitals). The specific combination of the above elements included in the
design of an individual center will be determined by the scientific aims of
that center and the resources that the participating partners have to offer in
addressing these aims.  Each application must justify the specific pattern of
collaboration in light of the scientific goals of the center.

Center Administration.  A director, affiliated with the applicant institution,
and a co-director(s), affiliated with the principal collaborating
institution(s), will be responsible for the scientific and administrative
leadership of the center.  An administrative advisory committee of senior
staff from the principal participating institutions will assist the director.
Membership on this committee may be supplemented as needed by individuals from
outside the participating institutions.  The role of this committee is to
provide administrative advice to the director by assisting in the preparation
of the application as well as advising the director on scientific and related
issues including faculty development activities.  In addition, an independent
scientific advisory committee consisting of consultants with appropriate
research experience and accomplishments, but who are not associated with the
participating institutions, will conduct an annual review of the: (1) broad
goals and accomplishments of the center including outreach, mentoring, career
development and training activities, (2) asses interim progress of all
scientific projects and their relevance to the broad objectives of this
initiative, and (3) aid in the review of pilot projects proposed after
initiation of the grant. NIDCR staff will serve as ex officio members of the
steering committee.  Also, a Data and Safety Monitoring Board (DSMB), formed
in accordance with NIDCR guidelines, is required for any prospective
randomized clinical trials research included within a center. Applicants
anticipating including a clinical trial as part of the center should obtain a
copy of the guidelines from the NIDCR staff listed under "INQUIRIES."

Research Projects.  The center will consist of a series of related research
projects and cores which, overall, focus on reducing craniofacial, oral and
dental health disparities.  At least four (4) of them will be R01-type
research projects.  Each project will involve participation by co-
investigators from the collaborating institutions.  Applicants must develop a
central theme around which the research projects are organized.  In being
consistent with the intent of this initiative, the theme should address basic,
translational and clinical, patient-oriented, health services, and community-
based research issues relating to health disparities (e.g., molecular
epidemiological studies, health promotion research, clinical trials).

In addition, each center is strongly encouraged to include, under its
administrative umbrella, related but already funded research as well as
research training and career development activities related to the specific
aims of the research. Reference to and descriptions of these grants along with
the specific scientific aims to which they apply should be contained in the
application.

Pilot Projects.  Each center may, in addition to regular research projects,
include short-term pilot projects.  The purpose of these projects is to
support pilot studies that can lead to regular research projects funded as
part of the center grant or as freestanding grants.  Each pilot project may
not be funded for more than $15,000 and for no longer than one year.  No more
than a total of five such projects may be supported in any single grant year. 
Administration of the projects should be within an administrative core as part
of the center development activities (see below). Applicants are limited to a
one-page description of each of the initially proposed pilot project. The
major focus of each description should be the overall purpose, specific aims
and general approach of the proposed pilot research.  Applicants also must
provide a detailed description of the process involved in selecting pilot
projects included in the center application as well as the process that will
be used in evaluating their outcomes and in selecting a new set of projects.

Core Facilities.  Core resources supporting center development activities,
outreach and educational activities, administrative services, unique clinical
facilities, biostatistical and computer services and shared equipment should
be included.  The level of support for core resources must be commensurate
with the level of research proposed and funded.  The center administrative
core must include support of meetings or other activities to explore new and
expanded collaborative research, research training, and career development
opportunities.  Travel for the director, co-director and developing scientists
to an annual meeting of center directors in Bethesda must be budgeted in the
administrative core as should support of travel for annual meetings of a Data
and Safety Monitoring Board for those centers that involve prospective
randomized clinical trials.

Equipment and Facilities.  No funding will be provided for major pieces of
equipment or renovation of existing facilities or building of new facilities.

Research and Training Networks

Receipt of a CRROHD carries with it the expectation that the center will
provide the impetus and core for research and training networks on health
disparities.  These networks can take on many forms and serve a variety of
purposes.  The purpose of the networks is to leverage the resources available
through the center, and in so doing to, facilitate research and research
training by linking these resources with other sites around the country where
the necessary expertise, facilities, capabilities and research opportunities
may be readily available.  Another function of the networks is to enhance the
opportunities by center staff for access to populations and communities that
may not be available locally.  One approach in forming a network could be the
establishment of collaborations among the centers that are funded through this
RFA. In facilitating this activity, NIDCR staff will organize annual
scientific meetings of center directors and staff in Bethesda.  Additional
collaborations between the CRROHD centers and other NIH funded grantees (e.g.,
NIDCR"s Comprehensive Oral Health Research Centers Of Discovery, NIDCR"s Oral
Cancer Centers, NIDCR"s Clinical Core Centers) as well as with other federal
agencies (e.g., HRSA Community/Migrant Health Centers, CDC Prevention Research
Centers, tribal urban and direct Indian Health Service clinics and hospitals)
are also encouraged as a way of establishing networks.  Applicants should
provide detailed plans and milestones for the formation of such networks
including a means for assessing progress and outcomes.

Research Career Development and Training Opportunities

While formal research training cannot be supported by this research grant
mechanism, it is understood that participation in research supported by this
initiative can have a significant impact on the career development of
underrepresented minorities in the scientific workforce.  Successful
applicants are strongly encouraged to use existing research training and/or
career development programs to encourage qualified and interested individuals
to participate in the research funded under this RFA.  Applications from
institutions that already have existing research training or career
development programs such as an institutional CLINICAL RESEARCH CURRICULUM
AWARD (K30) must include detailed plans for the use of these programs in
enhancing the research training and/or career development activities of
faculty participating in the research activities of the center.

Applicant institutions that do not have existing research training or career
development programs are expected to apply for parallel support for these
activities. In addition to the more traditional mechanisms in support of
training (i.e., National Research Service Award (NRSA) program, which can
support Individual fellowships (F32), institutional training (T32), and short-
term training (T35) awards) and career development (i.e., K23 þ Mentored
Patient-Oriented Research Career Development Award, K24 þ Mid-Career
Investigator Award in Patient-Oriented Research), the Research Centers at
Minority Institutions (RCMI) program of the National Center for Research
Resources may provide funds for faculty development activities for eligible
faculty members from RCMI eligible institutions.  Plans for the development of
these applications must be included in the center application.

Successful applicants are eligible to apply for funding to support under the
Research Supplements For Underrepresented Minorities Program as well as the
Research Supplements For Individuals With Disabilities Program.  A maximum of
one such supplement per project may be requested following an award. 
Information about these programs is available through the NIH Home Page
(http://www.nih.gov/) or the NIDCR Home Page (http://www.nidcr.nih.gov/) or by
contacting NIDCR staff listed under "INQUIRIES."

Evaluation of Impact

Congruent with the objectives of "Healthy People 2010" and as noted earlier,
the purpose of this RFA is to support research that will ultimately reduce
health disparities.  Thus applicants are asked to develop and outline an
evaluation process, including benchmarks, milestones and health status related
outcomes, that will allow an assessment of progress toward reducing the health
disparity(ies) through the research conducted by the center.  Suggested
measures include level or status of craniofacial, oral or dental disease,
including their potential influences on status of general health, in a sample,
community, or population being studied.  Other measures of success might
include extent of the adoption of preventive health practices within a group.

Scientific and Research Opportunities

While the overall intent of this initiative is to support research that leads
to a reduction in the craniofacial, oral and dental health disparities in
children (i.e., individuals from birth to 21 years), the scientific and
research opportunities for a given center can be broad. For example, an
individual center may focus on research aimed at understanding the
relationships between maternal oral health and infant morbidity and mortality
while another may focus only on that which addresses an oral disease of
childhood (e.g., dental caries, juvenile periodontitis).  Still other centers
might propose systematic studies and comparisons between populations and
subpopulations of ethnic and culturally distinct individuals while others
might propose studies aimed at uncovering the interrelationships between
socioeconomic/sociodemographic variables and biological underpinnings of
craniofacial, oral and dental diseases.

The thread common to all of the centers should be the development of knowledge
that will lead to an understanding of the biological, behavioral,
anthropological, sociological, and economic causes of oral health disparities
in the United States as well as to the design and testing of interventions
that will lead to the reduction and prevention of these health disparities. 
They should lead to the design of interventions that rely on and build upon
the cultural competencies involved in health of members of various groups. 
Multi- and inter-disciplinary research extending from the workings of the cell
to that of the community within which the individual lives is necessary to
reach a level of understanding that will help reduce disparities in disease
among the various groups.

Each center should be organized around a single scientific theme.  Proposed
studies should address the theme from a multi-disciplinary perspective and in
a way that will help lead to an understanding of health and disease
disparities as they relate to congenital craniofacial diseases and disorders,
orofacial injury, dental caries, periodontal disease, head and neck cancer,
autoimmune diseases, salivary dysfunction, chronic pain conditions and
response to pain, temporomandibular joint diseases and other chronic disabling
diseases of the craniofacial-oral-dental complex.  The theme can address a
specific health issue or set of issues involving craniofacial, oral or dental
diseases and disorders.  It can be directed at an assessment of any one or a
combination of biological, behavioral, psychological, sociological, economic,
educational, cultural or other factors that contribute to a particular health
disparity or to health disparities in general.  It can focus on either or both
prevention and treatment and it can be individual-, sample-, community-, or
population-based.  And, finally, the theme can represent a unique combination
of these possibilities.

In developing the theme, applicants may want to consider the following topics.
These are not listed in priority order nor are they comprehensive or
restrictive.  The final selection of a theme is the choice of the applicant
and may include any of the following:

o  incidence and prevalence of craniofacial, oral and dental diseases in
underserved populations and subpopulations including analyses of these data
for women,

o  the relative role of biological factors, physical environment,
socioeconomic factors, lifestyle and culture, ethnicity, and race in oral
health status,

o  the role of caregivers (e.g., persons and institutions) in the
craniofacial, oral and dental health or disease in children including the
relationship between the oral/systemic health of caregivers (e.g., siblings,
parents, grandparents, baby sitters, aunts/uncles, etc) and oral health of the
child,

o  impact of health care services, health care financing and insurance plan
design, reimbursement and organization (e.g., managed care) on the
availability of, access to, and utilization of high quality oral health care
services,

o  studies involving at the design and testing of effective health promotion
interventions involving community-based health education and information
dissemination activities regarding nutrition, reduction of tobacco use,
maternal, infant and child health care, head and neck cancer, diabetes,
substance abuse, degenerative bone diseases, and access to quality health care
services,

o  knowledge and use of health care practices and their influence on oral,
dental and systemic health,

o  oral manifestations of AIDS/HIV and other viral, bacterial or fungal
infectious diseases,

o  studies of the underlying genetic, nutritional, behavioral and
environmental factors involved in cleft-lip and palate and other craniofacial
diseases in U.S.-born and immigrant populations,

o  studies to establish the relationship between oral diseases (e.g., oral
infections) and diseases of other organ systems (e.g., diabetes,
cardiovascular disease, pre-term low birth weight babies) in underserved
populations or populations at higher risk for oral and/or systemic disease as
well as studies to design and test interventions aimed at reducing the disease
burden in these groups,

o  studies of the molecular events involved in tissue growth and wound healing
in underserved populations particularly following surgery for injury or for
soft tissue disease (e.g., oral/pharyngeal cancer) or injury,

o  studies designed to investigate factors contributing to the excess
morbidity and mortality associated with craniofacial and oral diseases (e.g.,
cancer and precancer, autoimmune diseases) in underserved populations, and

o  studies of dietary and nutritional factors in the prevention and treatment
of craniofacial, oral and dental diseases in underserved populations.

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 and
behavioral 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 Public Law 103-43.

All investigators proposing research involving human subjects should read the
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research," which was published in the Federal Register of March 28, 1994 (FR
59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No.
11, March 18, 1994, available on the web at:
http://grants.nih.gov/grants/guide/notice-files/not94-100.html.

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 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 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
also may obtain copies of these policies from the program staff listed under
INQUIRIES. Program staff may also provide additional relevant information
concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit a letter of intent that includes a
descriptive title of the proposed research, the name, address, and telephone
number of the Principal Investigator, the identities of other key personnel
and participating institutions, and the number and title of the RFA in
response to which the application may be submitted. 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 NIDCR staff
to estimate the potential review workload and avoid conflict of interest in
the review.

The letter of intent is to be sent to the program staff listed under INQUIRIES
by the letter of intent receipt date listed in the heading of this RFA.

INFORMATIONAL CONFERENCES

A series of regional informational conferences addressing the scientific and
administrative issues associated with this initiative will be held throughout
the United States.  Planned locations include Boston, Atlanta, Chicago, Dallas
and San Francisco.  Logistic information, including dates, times and locations
within each of the aforementioned cities, will be posted on the NIDCR home
page (http://www.nidcr.nih.gov/), will be announced through other media and
may be obtained from program staff listed under INQUIRIES.

APPLICATION PROCEDURES

Prospective applicants are encouraged to communicate with NIDCR Division of
Extramural Research scientific program and grants management staff as early as
possible in the planning stage of application.

The research grant application form PHS 398 (rev.4/98) is to be used in
applying for these grants.  These forms are available at most institutional
offices of sponsored research and from the Division of Extramural Research
Outreach and Information Resources, National Institutes of Health, 6701
Rockledge Drive, MSC 7910, Bethesda, Maryland 20892-7910, telephone (301) 435-
0714, Email: grantsinfo@nih.gov or from the internet website at:
http://grants.nih.gov/grants/forms.htm

When using the PHS 398 application form to respond to an RFA, applicants must
affix the RFA label available in the application kit to the bottom of the face
page.  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 in item 2a of the
face page of the application form and the YES box checked.  The RFA label and
line 2 of the application should both indicate the RFA number.  The sample RFA
label available at: http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has
been modified to allow for this change.  Please note this is in pdf format.

The instructions accompanying form PHS 398 must be followed as completely as
possible, but some modification will be necessary.  For example, a new Table
of Contents must be prepared giving page numbers for all items in the
application.  Pagination must be consecutive throughout the application. Each
subproject must be identified by number and investigator. Separate detailed
budgets for each year for the entire center, core resources, and subprojects
and pilot projects should be prepared.  A consolidated budget for the center
for all years of support should be included (use pages DD-EE, Form PHS 398). 
Direct and indirect cost estimates must be provided. Funds may be requested
for professional, technical, and administrative personnel, core resources,
equipment, supplies, consultant services, travel, publication costs, and
patient costs directly related to the research. Detailed justification of all
budget requests will be required and commitment of collaborating institutions
to the center should be fully documented.

A summary of financial support from non-NIDCR sources for studies that will
complement and expand the program supported by the NIDCR must be provided.  It
is important to explain how the support of these studies would further the
goals of the center and make it more cost effective.

Under Research Plan, the goals of the center must be described and background
and significance of the topics being addressed discussed.  Also, each research
project, core and the faculty development activities must be fully explained
in light of how they contribute to achieving these goals.  The organizational
and administrative structure, the responsibilities of the director and co-
director(s), individual investigators and the proposed mechanisms for
monitoring scientific progress must be described in detail.

Each research project must be presented as if it were a research grant
application (R01).  However, additional face pages are NOT necessary for each
research project.  There should be only one face page per center application. 
Instructions for pages 19-24 of form PHS 398 should be followed.  For the
Research Plan, a 25-page limitation will apply to each research project.  The
length of each core unit description may not exceed 25 pages.  A page BB
(Abstract form PHS-398) should be completed for the core resources, each
subproject, pilot project, and for the entire application.

The training/career development component of the application, including the
scientific proposal, the formal and informal course of study and the seminars,
journal club, plans to submit parallel applications for or to fold in existing
training/career development grants and other similar activities should be
submitted as an appendix to the application and should not exceed 10 pages.

Submit a signed, typewritten original of the application, including the
checklist, and three signed, photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040 þ MSC 7710
BETHESDA, MD 20892-7710
BETHESDA, MD  20817 (for express/courier service)

At the time of submission, two additional copies of the application must also
be sent to:

Dr. H. George Hausch
Division of Extramural Research
National Institute of Dental and Craniofacial Research
45 Center Drive, Room 4AN-38D þ MSC 6402
Bethesda, MD  20892-6402

Applications must be received by November 15, 2000.  If an application is
received after that date, it will be returned to the applicant without review.

REVIEW CONSIDERATIONS

Upon receipt applications will be reviewed by NIH staff for completeness and
responsiveness.  Applications that are incomplete, non-responsive to this RFA,
or exceed the first year budget limit of $1.5 million in total costs (i.e.,
direct plus indirect including any indirect costs associated with contracts or
consortia) will be returned to the applicant without further consideration.
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 NIDCR in accordance with the review criteria stated below.  As part of the
initial merit review, a process will be used by the initial review group in
which applications receive a written critique and 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, assigned a
priority score, and receive a second level review by the National Advisory
Dental and Craniofacial Research Council.  Funding from other NIH sources may
require secondary review by their national advisory bodies.

Review Criteria

Listed below are the review criteria to be used in the evaluation of the
applications, these criteria will be applied to competing continuations by
evaluating progress and to new applications by evaluating preliminary work and
plans for implementation of the new program.

Center (as a whole):

a.  Qualifications of center director, co-director(s) and key staff to provide
scientific and mentoring leadership.

b.  Integration between and balance among research projects, pilot projects
and cores and their relevance to the goals of the RFA to conduct research on
health disparities of children and their caregivers.

c.  The potential of the center to become or maintain itself as a regional and
national resource, including capacity to provide quality research training and
mentoring, opportunities for independent research career development, and
plans for research information dissemination and education activities. 
Included here will be an assessment of feasibility of plans for the
development of (1) research networks in support of the scientific aims of the
center and (2) parallel applications for research career development and
training awards.

d.  Appropriateness of the collaborations with respect to the scientific aims
of the center including the appropriate use of collaborations to access
appropriate populations for study and appropriate multi-disciplinary
scientific expertise from inter- and intra-institutional collaborations.

e.  Unique scientific contributions of the center, including significance,
innovation, scientific productivity, and recognition through publications, new
research grants, honors and awards.

f.  Multidisciplinary scope of the center, its cohesiveness, coordination, and
interrelation, and the synergistic potential among the center core and
projects.

g.  Evidence that the administrative structure of the center and collaboration
between institutions has functioned well in the development of the
application.

h.  Evidence of institutional support as well as support or potential support
for parallel activities (e.g., research training, related research projects).

i.  The degree to which the research, training, career development and
educational activities will enhance collaborative and/or interdisciplinary
research within the center and the research community as a whole.

j.  In addition to all of the foregoing criteria, competitive renewal
applications funded under the RRCMOH program will be assessed for the impact
of the Center during the previous grant period on expanding the knowledge base
concerning health disparities among U.S. populations, on providing research
opportunities for minority scientists by encouraging their participation in
craniofacial, oral and dental research, and on developing and strengthening
the biomedical and behavioral oral health research capacity.

k.  Adequacy of the evaluation plan to assess the extent to which research
conducted by the center will contribute to the reduction of health disparities
among children and their caregivers.

Research Projects (for each project):

a.  Significance: Does the project address an important problem?  If aims of
the project are accomplished, how will scientific knowledge be advanced?  What
will the effects of the project be on our knowledge about the causes of and
remedies for health disparities?

b.  Approach:  Are the conceptual framework, design, methods and analyses
adequately developed, well integrated and appropriate to the aims of the
project?  Does the investigator acknowledge potential problems and consider
alternative approaches?

c.  Innovation:  Does the project employ novel concepts, approaches or
methods?  Are the aims original and innovative?  Does the project challenge
existing paradigms or develop new methodologies or technologies?

d.  Investigator:  Is the investigator appropriately trained and well suited
to carry out the work?  Is the work proposed appropriate to the experience
level of the principle investigator and other researchers (if any) associated
with the project?

e.  Environment:  Does the scientific environment in which the work will be
done contribute to the probability of success?  Does the proposed study take
advantage of unique features of the scientific environment or maximize on the
collaborative arrangement among the components of the center?

Pilot Projects (as a whole):

a.  The extent to which the group of pilot projects as a whole is integrated
into and will contribute to the scientific aims of the center.

b.  Process for developing, selecting and monitoring progress of projects
included in the application as well as those that will be included in the
future.

Core Facilities:

a.  For each core, evidence that the core will provide the necessary support
required for the successful completion of projects and pilot projects.  In
addition, for competing continuation applications, evidence that this has
occurred.

b.  Qualifications of staff for each core.

c.  Quality and availability of core resources.

d.  Feasibility of the plan for recruitment of individuals from underserved
populations. In competing continuation applications, progress that has been
made in increasing participation of diverse populations in the center
activities.

AWARD CRITERIA

The earliest anticipated date of award is August, 2001.  Applicants should be
aware that, in addition to scientific merit, program priorities and program
balance, the total cost of the proposed project and the availability of funds
will be considered by the NIDCR staff and the National Advisory Dental and
Craniofacial Research Council in making funding recommendations. The NIDCR
appreciates the value of complementary funding from other public and private
sources, including foundations and industrial concerns, for activities that
will complement and expand those supported by the NIDCR.

INQUIRIES

Written, email and telephone inquiries concerning this RFA are encouraged,
particularly early in the application development process.  The opportunity to
clarify any issues or questions from potential applicants is welcome. All
inquiries should be directed to NIDCR staff listed below who may refer
questions to individuals from collaborating organizations and/or institutes.

Direct inquiries regarding scientific programmatic issues to:

Dr. Norman S. Braveman
Division of Extramural Research
National Institute of Dental and Craniofacial Research
45 Center Drive, Room 4AN-24A, MSC 6402
Bethesda, MD 20892-6402
Telephone: (301) 594-2089
FAX:  (301) 480-8318
Email:  Norman.Braveman@nih.gov

Inquiries regarding career development and NRSA training opportunities may be
directed to:

Dr. James A. Lipton
Assistant Director for Training and Career Development
Division of Extramural Research
National Institute of Dental and Craniofacial Research
45 Center Drive, Room 4AN-18J, MSC 6402
Bethesda, MD 20892-6402
Telephone:  (301) 594-2618
FAX:  (301) 480-8318
Email:  James.Lipton@nih.gov

Direct inquiries regarding grants management issues to:

Mr. Martin R. Rubinstein
Division of Extramural Research
National Institute of Dental and Craniofacial Research
45 Center Drive, Room 4AN-44A, MSC 6402
Bethesda, MD 20892-6402
Telephone:  (301) 594-4800
Email:  Martin.Rubinstein@nih.gov

SCHEDULE

Letter of Intent Receipt Date: July 17, 2000
Application Receipt Date: November 15, 2000
Scientific Review Date: January, 2001
Advisory Council Date: May, 2001
Earliest Award Date: August, 2001

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No.
93.121.  Awards are made under authorization of the Public Health Service Act,
Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC
241 and 285) and administered under PHS grants policies and Federal
Regulations 42 CFR 52 and 45 CFR Part 74.  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 and contract recipients to provide a
smoke-free workplace and promote the non-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.

REFERENCES

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.

Atchison, K. A. & Gift, H. C.  Perceived oral health in a diverse sample. 
Advances in Dental Research, 1997, 11: 272-280.

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.

Gift, H. C., Atchison, K. A., & Drury, T. F.  Perceptions of the natural
dentition in the context of multiple variables.  Journal of Dental Research,
1998, 77: 1529-1538.

Grumbach, K., Coffman, J. M., Young, J. Q, Vranizan, K., & Blick, N. 
Physician supply and medical education in California: A comparison with
national trends.  Western Journal of Medicine, 1998, 168, 412-421.

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.I

Kuthy, R.A., Odom, J.G., Salsberry, P.J., Nickel, J. L., & Polivka, B.J.
Dental utilization by low-income mothers.  Journal of Public Health Dentistry,
1998, 58: 44-50.

Kwan, S. L., Williams, S.A., & Duggal, M. S.  An assessment of the
appropriateness of dental health education materials for ethnic minorities. 
International Dental Journal, 1996, 46:277-285.

NIH Publication 98-4247.  Women of Color Health Data Book.  Office of Research
On Women"s Health, Office of the Director, National Institutes of Health,
1998.

Redford, M., Jeffcoat, M. & Silverton, S.  Oral Health. In Agenda for Research
on Women"s Health for the 21st Century: A Report of the Task Force on the NIH
Women"s Health Research Agenda for the 21st Century, Volume 2.  U.S.
Department of Health and Human Services, Public Health Service, National
Institutes of Health, NIH Publication No. 99-4386-1999.

Vargas, C.M., Crall, J.J., & Schneider, D.A.  Sociodemographic distribution of
pediatric dental caries: NHANES III, 1998-1994.  Journal of the American
Dental Association, 1998, 129,1229-1238.

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.  US 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.

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NIH Funding Opportunities and Notices

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