Subject: NIH GUIDE - RFA AA-91-04 - V20(25) 06/28/91 - P1/2
From: Dot Baker <[email-masked]>
To: [email-masked]
Date: Fri, 28 Jun 91 10:36 EST

Hi Paul,
At long last, this is part 6 of 6 of this week's NIH Guide.
Please post to the NIH Listserver as RFAAA-91-04(P1).910628.
Please let me know when they are posted so that I can let
everyone know.  I will await you call before sending memo.
Hope you have a nice weekend.
                Mary Broaddus
 
$$XID RFA AA9104 AA-91-04 P1O2 *****************************************
 
REQUEST FOR APPLICATIONS
 
RESEARCH ON THE PREVENTION OF ALCOHOL-RELATED PROBLEMS AMONG ETHNIC
MINORITIES
 
RFA:  AA-91-04
 
P.T. 34, FF; K.W. 0404003, 0745027, 0404000
 
National Institute on Alcohol Abuse and Alcoholism
Office for Substance Abuse Prevention
 
Application Receipt Date:  November 15, 1991
 
I. INTRODUCTION
 
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the
Office for Substance Abuse Prevention (OSAP) invite research
applications related to the prevention of alcohol-related problems among
ethnic minority groups.  NIAAA promotes prevention research on a broad
range of populations and is particularly experienced in the design,
review, and monitoring of outcome-oriented research; OSAP has focused on
the implementation and evaluation of prevention and intervention
programs, and service demonstration projects with minority populations
at both the individual and community level.  These convergences of
interest and expertise make it mutually advantageous for NIAAA and OSAP
to combine resources to encourage and facilitate alcohol prevention
research focused on Black Americans, Hispanic Americans, American
Indians, Alaska Natives, and Asian/Pacific Americans.  The primary
objective of this Request for Applications (RFA) is to expand the
limited information available about prevention strategies that are
effective for these minority populations since they are at elevated
risks for specific types of alcohol problems.  At the same time, the RFA
addresses the fact that these groups have diverse and distinctive
sociocultural characteristics that must be taken into account in the
development and implementation of prevention strategies.
 
The procedures for submission and review of grant applications and the
terms and conditions for grant support are given in sections V-XVII.
Applications received in response to the RFA will be assigned for review
and funding consideration in accordance with established Public Health
Service (PHS) guidelines.  The statutory authorities for these grant
awards are sections 301 and 510 of the Public Service Act (42 USC 241
and 290bb) and section 508(b)(10) of the Public Health Service Act (42
USC 290aa-6(b)(10).  This is a collaborative effort, jointly funded by
NIAAA and OSAP.
 
The 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, "Research on the
Prevention of Alcohol-Related Problems among Ethnic Minorities," is
related to the priority area of alcohol and other drugs.  Potential
applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary Report:
Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, D.C. 20402-9325 (telephone
202-783-3238).
 
II.  PATTERNS OF ALCOHOL-RELATED PROBLEMS AND ALCOHOL USE
 
In the United States, alcohol use is involved in nearly 100,000 deaths
annually(1), including approximately one-half of the nearly 50,000
fatalities in traffic crashes(2); 27,000 deaths due to cirrhosis of the
liver(3); and a high proportion of the deaths due to homicide, suicide,
drownings, falls, and other accidents.  Alcohol abuse results in
alcohol-related injuries and violence, serious medical consequences
including birth defects, marital discord, and job loss(4).  The economic
costs of alcohol abuse and dependence are projected to increase from $70
billion in 1985 to $86 billion in 1988(5).
 
These alcohol-related problems and costs are unevenly distributed across
racial and ethnic groups that also differ in their drinking patterns.
Surveys have found disproportionately high levels of alcohol consumption
and alcohol-related problems among some minority populations, in
particular subgroups of Black Americans, Hispanic Americans, American
Indians, and Alaskan Natives.  Asian/Pacific Americans, in contrast,
generally have been found to have low levels of alcohol use and
proportionately fewer problems(6).
 
Blacks
 
Blacks comprise the largest ethnic minority in the United States,
accounting for 12 percent of the total population.  On average, Black
populations tend to be younger than Whites and are underrepresented
among persons 65 years of age and older.  The socioeconomic status of
most Blacks is significantly lower than that of most Whites.
 
Alcohol-related Problems among Blacks
 
Results of a national survey of drinking problems and patterns conducted
in 1984 disclosed that Blacks, especially males, are at extremely high
risk for acute and chronic alcohol-related diseases such as cirrhosis,
alcoholic fatty liver, hepatitis, heart disease, and cancers of the
mouth, larynx, tongue, esophagus, and lung(7).  High rates of problem
drinking and alcoholism in high-density urban Black communities have
been associated with assaults, homicides, accidents, trouble with the
law, and family problems(8).  Several studies have concluded that Blacks
are at greater risk of accidents due to drinking than Whites; however,
since 1973 the drunk driving arrest rate for Whites 18 years of age and
older has risen greatly and now approximates that for Blacks.
 
Patterns of consumption among Blacks(9,10)
 
The high risk for alcohol-related problems among Black men is puzzling
given the similarity of their overall consumption pattern to that of
White men.  The two groups differ, however, with respect to the age
distribution of drinking.  Among Whites, frequent heavy drinking is most
prevalent between 18 and 29 years of age; among Blacks in that age
group, heavy drinking is much less frequent.  Between 30 and 39, the
rates of heavy consumption continue to be high for White men; those of
Black men rise sharply, surpassing those of the Whites.  Rates of heavy
consumption gradually decrease for men of both races after 40.  Racial
differences in consumption patterns are more pronounced among women and
are reversed in direction.  Nearly half of Black women were found to be
abstainers, compared with one-third of White women.  A smaller
proportion of Black women than White women are heavy drinkers.  Black
women in the 18-29 age group are significantly less likely to drink at
all or to drink heavily than are White women(11).
 
Socioeconomic status appears to have a different relationship to
drinking patterns in Black and White men.  As Black men's income rises,
rates of heavy drinking fall; while among White men, an increase in
income is accompanied by an increase in heavy drinking.  Among both
Black and White females, increases in income and education are generally
associated with a decline in abstinence and an increase in the frequency
of heavy drinking(12).
 
Hispanics
 
Hispanics now comprise 9 percent of the U.S. population, and that
proportion is likely to continue to grow as it has during the past three
decades(13).  The Hispanic population consists of several distinct
groups.  Mexican-Americans make up 60 percent of all U.S. Hispanics;
mainland Puerto Ricans comprise 14 percent; Cuban-Americans about 6
percent; and the remaining 20 percent come from other Spanish-speaking
countries of Central and South America and the Caribbean.  Although
these groups share a common language and certain cultural
characteristics, there are strong differences in their drinking patterns
as well as their relative economic standing, fertility rates, and age
distribution in the U.S.
 
Alcohol-related Problems among Hispanics
 
Hispanic males suffer disproportionately from alcohol dependence and
problems related to alcohol abuse compared with Black and White
non-Hispanic men in the U.S.(14) Several studies suggest that
Mexican-American men drink more and are more likely to have
alcohol-related problems than men in other major Hispanic subgroups,
although Puerto Rican men come close in some categories(15).  The
limited data suggest that alcohol-related illness is a significant
problem among Mexican-American men(16).  In contrast to the picture for
males, Hispanic women are at lower risk for alcohol dependency and
alcohol-related problems than are non-Hispanic White women in the U.S.
population(17).  Nevertheless, the proportion who drink and have alcohol
problems has been rising among second and third generation Hispanic
women.  In addition, Hispanic women are affected by Hispanic men's
alcohol abuse, which has an eroding effect on marriage and family life,
particularly where the wife is an alcohol abstainer and the husband an
alcohol abuser(18).
 
Consumption Patterns among Hispanics
 
Several epidemiological studies have found that alcohol use patterns
among Hispanics differ somewhat from those of the non-Hispanic U.S.
White population.  Specifically, Hispanic men drink less frequently but
consume larger amounts, have more instances of very heavy or binge
drinking, and have more instances of alcohol-related problems than
non-Hispanic White men.  Hispanic women abstain or drink infrequently,
usually in a family context.  Consumption rates among Mexican American
women are somewhat higher than those of women in other Hispanic
groups(19).  Among Mexican-American males, heavy drinking and associated
problems increase during their thirties and continue into older ages, in
contrast to non-Hispanic White males whose heavy drinking and
alcohol-related problems are greatest between 18 and 29 years of
age(20).
 
A study exploring drinking practices among Dominican, Guatemalan, and
Puerto Rican working class men in one Northeastern city found that
marked differences resulted from the interaction of social and economic
factors in the host country with the circumstances surrounding
immigration and the norms and practices of the country of origin(21).
For example, Dominican men immigrate legally and in family groups,
emphasize upward mobility and the work ethic, and limit drinking to
moderate amounts on weekends.  In contrast, Guatemalan men arrive as
undocumented workers, without their families, and are able to get only
short-term, low-paying jobs.  They adopt a transient social life
centered on male-only bars that results in heavy use of alcohol.
 
Acculturation also is related to Hispanic drinking patterns, although
the relationship differs by sex and nationality groups.  Male immigrants
appear to quickly adopt a drinking pattern that blends the high
frequency characteristic of U.S. male drinking with the Hispanic high
quantity-per-occasion practice(22).  Among Hispanic women, acculturation
is associated with increases in both the proportion of women who drink
and the amount they consume.  In contrast to the men, however, this
change in drinking pattern usually occurs in the first generation born
in the U.S. rather than in the immigrant generation(23).  The difference
between the drinking patterns of immigrant and first-generation Hispanic
women may reflect their differential adoption of the more egalitarian
social norms for women in the U.S.
 
American Indians and Alaskan Natives
 
The American Indian population numbers almost two million persons, or
about 0.8 percent of the U.S. population.  It is a rapidly growing,
highly fertile group whose median age was 22.9 in 1980, compared to 30.3
for the overall U.S. population.  The median age for those living on
reservations is only 19 years(24).  The American Indian and Alaskan
Native population is made up of over 300 tribes.  Although American
Indians are found in every State of the Union, most (over one million)
live in 32 Western States(25).  Alaskan Natives comprise 22 different
ethnic groups residing in 250 wide spread villages.  They constitute 15
percent (about 77,000) of the total Alaskan population of 512,000(26).
Approximately 46 percent of American Indians live in rural areas, 32
percent in small towns, and 22 percent in central cities(27).  In 1980,
37 percent lived on reservations or in Indian communities.  According to
the 1980 Census, the Indian unemployment rate was twice the national
average, and the median Indian family income was about half that for the
entire U.S. population(28).
 
Alcohol-related Problems among American Indians and Alaskan Natives
 
Data for 1978-1980 and 1983-1985, indicate that alcohol abuse is a
contributing factor in four of the ten leading causes of death for
American Indians:  accidents, chronic liver disease and cirrhosis,
homicide, and suicide(29).  Until recently, accidents were the leading
cause of death for Indians and Alaskan Natives in the 32 reservation
States(30).  An estimated 75 percent of all traumatic deaths and
suicides among Indians and Alaskan Natives are alcohol related(31).
Deaths from alcohol-related causes are particularly prevalent in the 25
to 44 age group.  Alaskan Natives have lower rates of motor vehicle
mortality than American Indians, but they have much higher rates of
other accident mortality related to water and air transport, as well as
firearm incidents.  Alaskan Native and American Indian females,
particularly those living in the West, are at increased risk for motor
vehicle and other injury-related deaths compared to U.S. females in
general.  Although the overall age-adjusted death rates for accidents
among Indians have decreased greatly over the years and are now only 2.2
to 2.3 times the national average, many tribes, particularly in the
West, have dramatically higher accident mortality rates than the
national average(32).
 
Fetal alcohol syndrome (FAS) is now believed to be the second most
frequent birth defect in the United States and a leading cause of mental
retardation(33).  Most identified cases of FAS in the United States have
come from study sites where the mothers are Black or American Indian and
of low socioeconomic status.  While the overall rate of FAS in North
America has been estimated at 2.2 per 1,000(34), the estimated rate for
Indian mothers is 6.1 per 1,000.  A 1980-1982 study of FAS incidence,
however, found that rates varied from 1.4 per 1,000 births among the
Navajo to 9.8 for the Southwest Plains tribes.  One fourth of the
American Indian mothers who produced one affected child had also
produced at least one other(35).
 
Consumption Patterns among American Indians and Alaskan Natives
 
Alcohol use varies tremendously from tribe to tribe:  some have fewer
drinking adults than the U.S. population, while others have more
drinkers.  The majority of all youth of most tribes, like the U.S. youth
population in general, report experimentation with alcohol(36).  But
drinking among American Indian youth is especially serious since Indian
mortality from alcohol-related causes is most common in younger
years(37,38).  Recreational and binge drinking appear to be
characteristic, particularly among young Indian adult males.
Descriptions of long-standing Indian alcohol consumption patterns stress
the importance of the social institution known as the "Indian drinking
party," a session in which alcohol beverages (usually beer or cheap
wines) are rapidly consumed until the supply is exhausted or the
participants lose consciousness(39).  These drinking patterns may
account for unusually high rates of alcohol-related arrests and
accidental deaths, particularly those associated with driving under the
influence.  In general, American Indian women drink considerably less
than men, but the prevalence of drinking among women is growing rapidly
in some tribes, which may account for the increase in the reported
incidence of FAS(40).
 
In a study comparing the drinking behavior of nonrandom samples of
Sioux, Californian, Navajo, and Eastern Oklahoma Indians on and off the
reservation, it was found that most rural Indian groups had a lower mean
consumption rate than urban ones.  Typically, the rural participants
drink once or twice each month--when lease money, unemployment, welfare,
and/or general assistance payments arrive.  The group means among the
urban samples are one or two drinking sessions per week, a pattern that
coincides with pay schedules in urban-based industries and social
services(41).
 
Asian/Pacific Americans
 
The 7.3 million Asian/Pacific Americans now comprise 2.9 percent of the
U.S. population.  In the past decade, the size of the Asian/Pacific
population has more than doubled and its diversity greatly expanded.
Through most of this century, the Japanese and Chinese constituted the
largest Asian American subpopulation groups; it is estimated that by the
year 2000, however, the Filipinos will be the largest subgroup, followed
by the Chinese, Vietnamese, Koreans, Indians, and Japanese(42).
 
Alcohol-related Problems among Asian/Pacific Americans
 
Currently available data suggest low rates of alcohol-related problems
among Asian/Pacific Americans, even among those identified as heavy
drinkers(43).  This finding has been attributed to ethnic differences in
physiological reactions (i.e., the "flushing response") as well as
sociocultural and environmental factors(44).  Among the cultural factors
contributing to low rates of alcoholism are norms that permit drinking,
particularly at social functions, but that discourage drinking to
excess, and tight family and community regulation of alcohol use.  These
factors have been combined into a "reciprocity model" explaining the
alcohol consumption of Asians(45).  It has been suggested that the
growing numbers and heterogeneity of Asian immigrants, as well as the
progressive assimilation of Asian Americans to American values, soon
will make the existing data regarding Asian drinking problems obsolete.
 
Consumption Patterns among Asian/Pacific Americans
 
Studies consistently suggest that Asian Americans use and abuse alcohol
less frequently than non-Asian individuals(46).  In one study examining
differences in alcohol consumption among residents of Hawaii,
researchers found that Native Hawaiians and Caucasians reported higher
levels of alcohol use than Chinese Americans, Japanese Americans, and
Filipino Americans(47).  In several studies focusing on drinking
patterns among Asians in the U.S., however, the view of Asian/Pacific
Americans as non-drinkers was questioned(48).  Variations in drinking
patterns by ethnicity as well as age and sex in an examination of
Chinese, Japanese, Koreans, and Filipinos in Los Angeles were found.
Among Korean men, for example, 46 percent were abstainers, 28 percent
moderate, and 26 percent heavy drinkers.  In contrast, 31 percent of the
Chinese men were abstainers, 55 percent were moderate drinkers, and only
14 percent heavy drinkers.  Japanese and Filipino men were like the
Chinese in the proportion of abstainers (33 and 35 percent,
respectively), but like the Korean men in the proportion of heavy
drinkers (29 percent of each group).  Women drank less than the men in
all four groups but differed from each other as well.  While most
Chinese, Korean, and Filipino women are abstainers (69, 82, and 80
percent, respectively), and virtually all the rest were moderate
drinkers, most Japanese women (55 percent) were moderate drinkers and 12
percent were heavy drinkers.  Those data suggest that Asian Americans
display diverse drinking styles, including a relatively high proportion
of heavy drinkers among Japanese and Filipino men.  The same study found
that those Asian/Pacific Americans most likely to drink are men under
the age of 45 who have higher social status.  Their attitudes toward
alcohol use were permissive and their friends tolerant of drinking(49).
 
III.  THE CURRENT STATE OF PREVENTION RESEARCH ON ETHNIC MINORITIES
 
Most alcohol prevention research among ethnic minorities has been
concerned with the treatment of alcoholism.  Furthermore, until quite
recently, the prevention of alcohol abuse and alcohol-related problems
among ethnic minorities received relatively little attention.  Moreover,
little of this research has been rigorously evaluated.
 
The creation of OSAP in 1986 has fostered an exponential growth in the
number of prevention programs to deter alcohol and drug use,
particularly those among high-risk youth and minority populations.  In
1987, for example, OSAP initiated 130 demonstration projects focused on
high-risk youth and their families, including prevention projects
targeted at ethnic minority groups(50).  Many of those OSAP projects
included evaluations that have not yet been published.
 
Prevention Research Concerning Black Americans
 
An intensive search of the prevention research literature identified a
number of primary and secondary prevention efforts focused on
alcohol-related problems in the Black population of the U.S., but none
reported a systematic evaluation of program effects(51).  Among the 130
demonstration projects initiated by OSAP in 1987, 24 focus on Black
high-risk youth and their families(52).
 
Prevention Research Concerning Hispanic Populations
 
A comprehensive review of alcohol prevention programs targeted at
Hispanic populations found that only one of these (the Ganadores
["Winners"] project) has resulted in a systematic evaluation that was
published(53).  The interventions implemented in that program included
mass media messages and community-based activities designed to increase
awareness of the dangers of alcohol and to change attitudes toward
alcohol use and drinking behavior.  The community activities included
dissemination of educational materials and oral presentations by
community leaders designed to make people think more about their own
drinking.  The program resulted in an increase in reported awareness and
knowledge of the dangers of alcohol, but it did not change drinking
behavior(54).  A later review of the literature identified nine other
recent projects aimed at alcohol prevention among U.S. Mexicans, but
only a few of these had been evaluated (55,56).
 
Those programs without evaluations include efforts involving community
planning and organizing by grassroots organizations, after-school
youth/education programs, and prevention efforts targeted at specific
segments of the population, such as pregnant women(57).
 
Prevention Research on American Indians and Alaskan Natives
 
Most primary prevention programs aimed at American Indians in recent
years have been school-based, youth-oriented programs emphasizing
information about the effects and consequences of alcohol and other
substance abuse.  Their effectiveness is largely unknown(58).
 
Several programs designed to provide youth with coping skills, however,
have reliably documented systematic research efforts.  For example, a
modest success was reported for a bicultural skills enhancement program
delivered in reservation and non-reservation settings in the Pacific
Northwest.  At a six-month follow-up, the test group had better
knowledge of drug effects, better interpersonal skills for managing
pressures to use alcohol and other drugs, and lower rates of alcohol,
marijuana, and inhalant use than the control group(59).
 
Indian communities also have instituted community-wide prevention
programs using local resources and Federal government funds.  A
1986-1987 survey of community programs funded by the Indian Health
Service (IHS) identified a total of 312 communities involved in
community-based alcohol/substance abuse prevention and intervention
programs.  These programs provided a variety of services, including
alcohol and drug education activities designed to build self esteem and
coping skills, improve decision-making skills, and promote family
bonding and enrichment.  No reliable evaluation of the effects of these
programs was reported in the presentation of survey results(60).
 
In 1983, the IHS introduced a program to prevent FAS by providing
American Indian and Alaskan Native communities throughout the country
with the knowledge, skills, and strategies to initiate prevention
measures on their own.  The chief element of the program was the
training of cadres of trainers/advocates in all local communities served
by the IHS to impart FAS information to a variety of audiences.
Evaluation results showed a significant gain in knowledge and retention
over an extended period of time by the target populations(61).
 
Prevention Research with Asian/Pacific American Populations
 
Low rates of alcohol-related problems have contributed to the absence of
prevention research targeted at the various Asian/Pacific
subpopulations.  Six of the ongoing OSAP prevention demonstration
projects, however, are targeted at Asian/Pacific youth and community
groups.
 
IV.  RESEARCH AGENDA
 
The sociocultural characteristics of ethnic minority populations, and
the paucity of rigorous research on the prevention of their
alcohol-related problems indicate a need for a variety of prevention and
pre-prevention studies directed specifically to these populations.
 
Prevention research investigates ways of reducing the adverse personal
and social consequences of alcohol abuse.  It is guided by the public
health model that views alcohol-related problems as arising through a
complex of individual, interpersonal, and social factors.  In this view,
three major elements act together either to produce or attenuate
specific problems.  These elements are:
 
  o  the agent -- alcohol beverages or ethanol itself;
 
  o  the individual (host) -- traits that affect a person's
     susceptibility or vulnerability to the effects of alcoholic
     beverages; and
 
  o  the environment -- physical, interpersonal, or social milieu
     surrounding the use of alcohol that either regulates the
     individual's exposure to the agent or mediates the risk that the
     agent poses to the individual(62).  This element includes the legal
     environment (alcoholic beverage control (ABC) laws and minimum
     purchase age laws); the economic environment (pricing, the excise
     tax rate, and sales promotions); the normative environment (general
     attitudes and beliefs regarding alcohol and mass media effects);
     and the physical aspects of the drinker's immediate surroundings.
 
Research that implements and tests intervention strategies to reduce or
prevent alcohol-related problems in one or more of the target ethnic
minority groups may focus on entire communities, specific environments
or high-risk groups, or individual behavior.  Regardless of the nature
of the intervention, however, the research plan must include evaluation
of all phases of the effort.  This entails gathering objective evidence
establishing what the program elements were, how they were delivered,
and what effects the program had on the targeted populations.
 
Preintervention studies also are needed to explore sociocultural factors
that may contribute to the occurrence or reduction of alcohol-related
problems among ethnic minorities.  Findings from such research may then
serve as the foundation on which to develop more effective
interventions.
 
Of central importance in the planning and execution of these studies is
careful attention and sensitivity to the unique aspects of the culture
of the group(s) under study.
 
Environmental Prevention Strategies
 
A number of studies of environmental prevention strategies in the
general population have documented the effectiveness of economic,
social, and legal controls in limiting the availability of and demand
for alcohol.  However, little information is available about the effects
of these strategies on ethnic minority populations.  This is true for
several reasons:  ethnic minorities have not often been the focus of
environmentally oriented intervention studies; most national studies are
designed to provide baseline data on the general population and the
ethnic minority samples from these surveys are too small to yield
definitive information about these populations; and data regarding
ethnic status are not included in many relevant regular data collection
efforts (e.g., the Fatal Alcohol Reporting System).
 
A systematic program of research investigating the effectiveness of
environmental prevention strategies in minority settings is needed to
explore interventions designed to change the incentives, opportunities,
risks, and expectations that surround drinking.  This includes
examinations of the impact on Black, Hispanic, Native American, Alaskan
Native, and Asian communities (or high-risk groups within them) of
national, state, or community-wide policies designed to control alcohol
availability and reduce demand for such products.  Policy changes might
be expected to have diverse effects on minority ethnic populations
because of differences in sociocultural patterns of drinking as well as
differences in the manner in which such policies are viewed in different
communities and the ways they are enforced.
 
Availability Control
 
Strategies that might be tested in ethnic minority contexts that control
the physical and economic availability of alcoholic beverages include:
(1) strengthening and/or enforcing ABC laws regulating the hours of
operation and the location and number of outlets for sales of alcoholic
beverages; (2) enhancing enforcement of minimum drinking age laws; (3)
implementing server training programs; and (4) raising taxes on
alcoholic beverages.
 
Raising the minimum drinking age to 21 appears to have reduced both the
consumption of alcohol by persons under 21 and the incidence of driving
after drinking(63).  Nevertheless, the widespread use of alcohol by
adolescents and young adults suggests that the law has not eliminated
access to alcohol or deterred a high proportion of adolescents from
drinking(64).  The differential effects of changes in the minimum
drinking age laws on various ethnic groups are unknown.  Does access to
alcoholic beverages by underage persons and the enforcement of minimum
age drinking laws vary by ethnic status?
 
Many Black and Hispanic communities appear to have a disproportionate
number of alcohol outlets.  This observation led some communities to
seek to reduce the number of outlets and limit alcohol availability
through vigorous enforcement of zoning ordinances and licensing
regulations.  Research is needed on the effectiveness of such efforts as
well as their impact on alcohol-related problems in Black and Hispanic
communities.  A similar research effort might be focused on localities
in the vicinity of "dry" Indian reservations(65).  What are the effects
of various tribal proscriptive and prescriptive policies on Indians'
patterns of drinking behavior(66)?  In general, these studies should
seek to determine if there is evidence of differential enforcement of
alcohol control in ethnic minority and White communities, either in the
form of patterned evasions of the law or more stringent enforcement.  If
such patterns are found, it would be desirable to explore their impact
on alcohol-related problems in those communities.  In addition,
investigators might examine whether or not minority persons perceive
there to be differential enforcement and how such perceptions might
affect minority individuals' alcohol-related behavior.
 
Server Training
 
Server training programs recently have been implemented to assist those
responsible for serving alcohol in bars and restaurants in controlling
heavy drinking.  The few studies to date suggest that such programs have
been effective in reducing the rate and amount of consumption by patrons
and the probability of patron intoxication(67).  Because servers can
tailor their actions to specific drinkers, they have the opportunity to
control drinking in culturally appropriate ways.  Research is needed to
develop culturally-sensitive training programs for alcohol beverage
servers and to determine whether or not such training enhances the
impact of the intervention in bars and restaurants that serve primarily
minority clientele.
 
Price Increases
 
Econometric studies have suggested that an increase in the price of
alcoholic beverages would result in decreases in both alcohol-involved
automobile crashes and rates of cirrhosis mortality(68,69).  Projections
based on these studies have indicated that a tax on beer amounting to 35
percent of the retail price would halve the number of alcohol-related
fatalities among 16- to 20-year-old drivers(70).  Research is needed to
determine whether or not these relationships and projections also apply
to various ethnic minority groups.  How might price changes resulting
from higher taxes affect consumption among different nationality,
tribal, and socioeconomic subgroups within the larger ethnic categories?
Such research might well be based on reanalysis of existing data.
However, experimental investigations of the effects of changes in the
price of alcoholic beverages (through taxation) might be possible in
some community studies, particularly on American Indian reservations
that have the authority to determine their own alcohol policies.
Research might also analyze the sociopolitical forces supporting and
opposing such changes.
 
Prevention Strategies Focusing on the Individual
 
Prevention efforts targeted at individuals have attempted to change the
individual's knowledge about alcohol effects and attitudes about the use
of alcohol as means of changing consumption practices.  These efforts
usually involve the use of media campaigns and school-based
instructional programs.  By and large, such efforts have had mixed
success for general populations.  They sometimes have produced desired
changes in knowledge and attitude but, for the most part, they have not
been shown to result in behaviorial changes(71).  School-based programs
that teach youth peer pressure resistance and social competence skills
for avoiding the use of alcohol and other drugs show promise but have
moderate or short-lived effects (72).  Even this conditional
effectiveness, however, has not been established for ethnic minority
students.
 
Recently reported results from a long-term program, the Midwestern
Prevention Project, indicate that significant decreases in consumption,
as reflected in self-reports, were observed in students over a period of
four years, from the sixth to the tenth grades(73).  Unfortunately,
results specific to minority students in the program have not yet been
reported.
 
The more positive results of this study may be due to the integration of
the school-based program with collective environmental
influences--including parents, community leaders, and mass media.
 
Adapting General Interventions to Ethnic Minorities
 
Although most school-based programs have not been shown to lead to
changes in behavior, the logic of early intervention and potential for
mass diffusion of such programs, nevertheless, suggest the desirability
of continuing to seek ways to affect the behavior of youth and
adolescents.  One possible research strategy involves further scrutiny
of those programs that have been successfully tested in the general
community but need adaptation to ethnic minorities and evaluation of
their efficacy.
 
It would be particularly valuable to replicate the results of the
Midwestern Prevention Project in ethnic minority populations.  Other
programs using the social influence model that have shown more limited
positive outcomes also might be adapted for implementation with one or
more ethnic minority groups(74).
 
Replicating Ethnically-based Programs
 
Another possible research approach is systematic testing of prevention
programs that appear to have been successfully implemented within ethnic
communities but were tested on only a limited scale and/or not
systematically evaluated.  Examples of these include the community-based
programs summarized by the IHS(75) and various demonstration programs
that employ social learning models and are targeted at high-risk
youth(76).
 
Focus on High-risk Groups
 
Within each ethnic minority, it is important to target intervention
efforts at high-risk groups, particularly youth and pregnant women.
This may call for creative techniques for reaching these groups and
multifaceted approaches for intervening with them, since the
highest-risk adolescents frequently are absent or have dropped out of
school, and alcohol-abusing pregnant women often fail to seek prenatal
care.  Programs to prevent FAS, for example, might seek to develop a
support network to facilitate abstinence during pregnancy that would
include peer counseling, family involvement, and communitywide
interventions (i.e., a comprehensive, multiple system strategy)(77).
 
Research on Hispanics should particularly target the drinking patterns
of immigrant men and of upwardly mobile women and their families.
Studies of Blacks might focus fruitfully on men who are moderate
drinkers, since Blacks are experiencing higher rates of alcohol-related
problems than White men with similar levels of consumption, for reasons
that are not clearly understood(78,79).  The increase in heavy drinking
and alcohol-related problems among Blacks and Hispanics during their 30s
suggests the need for interventions with this age group.
 
Culturally-based Health Awareness Programs
 
Several aspects of the Hispanic culture related to alcohol use have
implications for alcohol abuse prevention strategies and research:  (1)
the culture does not regard heavy drinking as inappropriate behavior,
(2) alcohol abuse is not widely recognized as a health problem, and (3)
alcoholism is viewed as a personal lack of willpower(80).  These
findings suggest the need to test interventions designed to increase
awareness of the seriousness of alcohol problems that also address the
role of cultural values as contributors to (and potential moderators of)
problematic drinking practices.  Similarly, strategies designed to
increase Blacks' awareness of alcohol problems and of the relationship
of cultural attitudes and environmental forces to these problems may be
useful.  These may first need to determine how the target groups define
"alcohol dependence" and "excessive" or "inappropriate" alcohol use
before it will be possible to develop messages for the prevention of
cirrhosis, homicide, and other alcohol-related health problems.
 
Identifying Protective Factors
 
Research on alcohol-related problems tends to focus exclusively on
identifying stressors and factors that place individuals at high risk.
A promising alternative approach is to explore coping resources and
protective factors that have resulted in the absence of alcohol problems
among minority individuals, particularly those exposed to "high risk"
environments.  What institutional and interpersonal supports enable them
to overcome adverse environments?
 
Prevention Building Blocks
 
Developing effective intervention programs among minority populations
requires a stronger knowledge base than now exists about the
sociocultural and economic factors related to the use of alcohol that
shape attitudes, values, behavior, and norms regarding alcohol use among
these groups.  Sociocultural factors that require further study within
ethnic minority communities include:  socialization processes and the
role of the family; peer group influences on alcohol related behavior;
acculturation and the change process in response to immigration and
migration; the effects of gender roles on alcohol consumption patterns;
the effects of mass media messages; and the contributions of community
institutions to alcohol use and abuse.
 
Socialization and the Role of the Family
 
For most people, the family is the initial source of knowledge about and
attitudes toward alcohol.  Data on alcohol socialization in ethnic
minority families, however, are limited.  Research might explore the
extent to which home-based teaching about alcohol use is prescriptive or
proscriptive, how the quality of parent-child relationships affects
alcohol use patterns, and how alcohol socialization may vary by social
class and national origin (for Hispanics and Asians) or tribe (for
Indians).
 
Peer Group and Cohort Studies
 
Research is needed to determine the norms and values prevalent in young
adult peer groups in each of the ethnic minority populations as they
relate to alcohol use and risk taking.  What interventions might impede
the formation of alcohol-using "peer clusters" and encourage the
formation of peer clusters that provide sanctions against alcohol
use(81)?  The increase in heavy drinking and alcohol-related problems
among Blacks and Hispanics in their 30s, in contrast to the age-related
drinking patterns of Whites, also is particularly important for further
study.
 
Immigration and Acculturation
 
Many Blacks and Indians in the past several decades have moved from
rural and tribal areas to cities; many Hispanic Americans and
Asian/Pacific Americans are immigrants.  The differences observed in
drinking patterns by residence and immigrant cohort suggest the need for
further studies of the factors surrounding urbanization, immigration,
and acculturation as they relate to alcohol use.  To fully understand
acculturation, it is also necessary to consider the effects of such
factors as immigrants' economic status, social interaction patterns,
employment opportunities, and access to alcoholic beverages as
intervening variables in the change process.
 
Members of ethnic minorities living in a larger society are, to varying
degrees, bicultural.  Bicultural membership may be particularly
stressful during adolescence, as minority youth learn that their
cultural values at home are not necessarily recognized or valued at work
or school.  Research is needed to address minority members' alcohol
problems within the perspective of biculturality and explore the
possible contributions to alcohol-related problems of value conflicts in
different social situations.  Such findings can provide a foundation on
which to build more effective programs to prevent those problems(82).
 
Gender Roles
 
"Machismo" is alleged to be a basic part of Hispanic culture defining
"manhood."  Because it appears to include elements relating to the use
of alcohol (e.g., positive valuation of the ability to drink large
quantities), research is needed to more adequately understand its
meaning as related to drinking behavior.  Such findings might serve as a
basis for interventions designed to draw on the positive aspects of
"machismo" to moderate the drinking patterns of male peer groups.
Similar research on the definition of "manhood" in Black, Indian, and
Asian/Pacific communities and its relation to drinking behavior also
could be useful in designing effective prevention strategies.
 
Epidemiological data suggest an increase in alcohol use among women,
particularly more acculturated women in Hispanic and Indian communities.
Further research is needed on the relationship of changing sex role
norms to changes in minority women's patterns of alcohol consumption and
the meaning of drinking to women.
 
Examination of Media Messages
 
It is widely believed that the mass media have an important impact on
perceptions, attitudes, and beliefs regarding alcohol although research
evidence is equivocal(83).  In the past decade, the alcohol industry
increasingly has focused advertising on ethnic communities(84).  This
suggests the need to explore the effects of focused advertising on the
definitions of appropriate drinking behaviors specific to minority
subcultures and to age, sex, and socioeconomic subpopulations within
ethnic groups.  In addition to commercial advertising, research is
needed on ethnic groups' reactions to public service messages and
fictional television and radio programming related to alcohol.  Who are
the most credible communicators within various ethnic groups--national
or local public figures, mass media or sports "personalities," others
who have wealth, professional achievements, or other prestigious
attributes?  In what language and in which medium (i.e., radio,
television, or print) are messages most effective in reaching the
various ethnic groups (and subgroups) with regard to prevention
approaches?  Answers to these questions will provide a foundation on
which to build more effective health promotion programs.
 
Institutions
 
Within ethnic communities, institutions such as churches, business
groups, schools, and local political bodies may play important roles in
addressing alcohol problems.  Little is known about whether or not and
in what ways such influence is exerted in ethnic communities in
addressing alcohol problems.  For example, how have churches and
businesses in the Black community contributed to the prevention of
alcohol abuse among Blacks?  To what extent have institutions such as
the beverage and hospitality industries contributed to or deterred
prevention efforts through, for example, server training programs or the
sponsorship of cultural and athletic events?  To what extent have
organizations such as Mothers Against Drunk Driving (MADD) gained
support in implementing prevention programs in minority communities?
Are indigenous organizations more effective than those that are
primarily oriented toward Anglo constituencies?
 
V. METHODOLOGICAL ISSUES
 
Research in the areas discussed above may be cast within any of the
standard research traditions, and it may be descriptive, exploratory, or
directed to the search for causal relations.  Investigators may use the
research methodologies of any scientific discipline that can contribute
to this area of prevention research.  The methodological tradition
within which the research is cast will be determined by the nature of
the problem investigated and the circumstances under which the research
will be carried out.
 
Studies on the prevention of alcohol-related problems among ethnic
minorities must be conceived and executed to satisfy the usual criteria
of scientific merit.  If applicants do not have the full range of
methodological and technical skills requisite to the design and analysis
of the proposed research, they are strongly urged to consult with
statisticians or other relevant specialists who may, in addition, be
included in the proposal for help in the design, analysis, and
interpretation stages of the project.
 
Cultural Sensitivity
 
There is widespread agreement that prevention research on ethnic
minorities requires an acquaintance with the culture of the target
group(85).  Concern with issues of cultural sensitivity suggests the
need to consider, for example, inclusion of members of target minority
groups in the planning and implementation of research programs or the
use of the language of the target group in communications and data
collection.  The applicant may wish to ensure the availability of the
requisite cultural information by including an ethnographer or other
relevant specialist as a consultant in the proposal.
 
Indeed, both cultural sensitivity and methodological considerations
suggest that a clear cooperative arrangement between community
organizations or agencies and researchers is an essential ingredient for
the successful implementation and evaluation of an intervention
strategy.
 
Measurement
 
There may be special problems associated with using measures of alcohol
consumption formulated for the dominant majority culture.  For example,
the consistency of consumption, the standard drink equivalents, and the
standard time frame referred to may be less familiar and less relevant
to some ethnic groups.  The pattern of binge drinking followed by
periods of abstinence that occurs in some Indian tribes may not be
captured by consumption measures based on regular recall periods(86).
The measurement of alcohol consumption by self-reports may produce
especially biased results with ethnic minority subjects because of
concerns of social desirability.  In general, the validity of standard
tests and measuring instruments may need to be explicitly established
for the relevant ethnic populations.
 
Design
 
The research proposed may employ cross-sectional and longitudinal
designs, separately or in combination.  Whenever possible and
appropriate, applicants are encouraged to use longitudinal designs.
Although longitudinal studies are costly, difficult to execute, and
entail long-term commitments by researchers and sponsoring agencies,
they are the most appropriate structures for the investigation of
processes and events that develop over time.
 
In research, to establish the efficacy of an intervention, it is
important to include appropriate comparison groups.  Random assignment
of intervention is the single most powerful procedure for establishing
appropriate comparison groups.  However, if random assignment is not
feasible or of limited statistical power, the application may propose
alternative approaches, such as quasi-experimental designs and time
series analyses.
 
Sampling
 
The generalizability of a study's findings is affected by the procedures
by which subjects are chosen for study.  Random selection at some stage
in drawing samples is necessary to justify generalization of findings
using principles of statistical inference.  There are some
nonprobability sampling practices often encountered in research with
human subjects that compromise the generality of the results.  If
subjects are permitted to volunteer for participation in a study, or
they leave the study on a nonrandom basis, potentially serious and
unspecifiable biases may result.  Longitudinal studies are particularly
at risk for uncontrolled sample attrition.  Also, samples chosen on the
basis of convenience rather than by probability-based methods are likely
to be biased in unknowable ways.  The researcher must seek to avoid
these problems or find ways to compensate for them.
 
Evaluation
 
Prevention research involving interventions must include comprehensive
evaluation components that are conceptually and procedurally integrated
with the overall research program.  The three areas of evaluation
(formative, procedural, and outcome) provide information relevant to the
interpretation of the research findings.  Evaluation bears directly upon
the verification of the research hypotheses connecting interventions to
outcomes.
 
  o  Formative evaluation assesses the degree to which the instruments
     and procedures employed in the project have the properties required
     for the interventions of which they are a part.  For example, an
     intervention with beverage server training requires a training
     program that instructs servers how to detect when a patron has
     reached a specified limit of alcohol consumption.  The training
     program must be developed and tested before it is employed in the
     research program.
 
  o  Procedural evaluation refers to the periodic monitoring of the
     implementation of interventions during the course of the research
     to assure adherence to protocol and to document what actually was
     being done.  Using the same responsible server example, it is
     necessary to ascertain whether or not the servers utilize their
     training effectively and dependably on the job.  This phase of
     evaluation is essential to assessing the appropriate execution of
     the intervention.
 
  o  Outcome evaluation is concerned with determining whether or not the
     program achieved its objectives, i.e., whether or not the outcomes
     hypothesized to be caused or produced by the interventions did in
     fact occur.  This phase of the evaluation process requires the
     specification of a verifiable causal linkage between the
     interventions and the events or behaviors whose encouragement or
     avoidance is the ultimate target of the interventions.  In the
     responsible server example, the assumption is that patrons of
     program establishments are less likely to be involved in an
     automobile crash within an appropriate time period after leaving
     the establishment than are patrons of control establishments.  A
     recent review of server training programs indicates that all
     programs were evaluated on factors relevant to this assumption,
     e.g., on the impact of the training program on servers' behavior or
     on their customers' consumption of alcohol(87).  Even more cogent
     evidence of the effectiveness of the intervention, however, would
     be a comparison of the accident rates of patrons of program and
     control establishments.
 
VI.  ELIGIBILITY
 
Applications may be submitted by public or private, nonprofit or
for-profit, organizations such as universities, colleges, hospitals,
research institutes and organizations, units of State or local
governments, and eligible agencies of the Federal government.  Women and
minority investigators are encouraged to apply.  Foreign institutions
are eligible to apply.
 
VII.  SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF
ADAMHA POLICIES CONCERNING INCLUSION OF WOMEN IN CLINICAL RESEARCH STUDY
POPULATIONS
 
Applications for ADAMHA grants and cooperative agreements are required
to include women in study populations for clinical research, unless
compelling scientific or other justification for not including them is
provided.  This requirement is intended to ensure that research findings
will be of benefit to all persons at risk of the disease, disorder, or
condition under study.  For the purpose of these policies, clinical
research involves human studies of etiology, treatment, diagnosis,
prevention, or epidemiology of diseases, disorders or conditions,
including but not limited to clinical trials.
 
Applications should include a description of the composition of the
proposed study population by gender as well as by racial/ethnic group
and the rationale for the numbers and kinds of people selected to
participate.  This information should be included in the form PHS 398,
in Section 2, A-D, of the Research Plan AND summarized in Section 2, E,
Human Subjects.
 
Applications should incorporate in the study design gender
representation appropriate to the scientific objectives of the work
proposed.  If the representation of women in sufficient numbers to
permit assessment of differential effects is not feasible or is not
appropriate, the reasons for this must be explained and justified.  The
rationale may relate to the purpose of the research, the health of the
subjects, or other compelling circumstances (e.g., if in the only study
population available there is a disproportionate representation in terms
of age distribution, risk factors, incidence/prevalence, etc., of one
gender group).
 
For foreign awards, the policy on inclusion of women applies fully;
since the definition of minority differs in other countries, the
applicant must discuss the relevance of research involving foreign
population groups to the United States' populations, including
minorities.
 
If the required information is not contained within the application, the
application will be returned.  Peer reviewers will address specifically
whether the research plan in the application conforms to these policies;
and if the gender representation/justification is judged to be
inadequate, reviewers will consider this deficiency in assigning the
priority score to the application.
 
All applications/proposals for clinical research submitted to ADAMHA are
required to address these policies.  ADAMHA funding components will not
award grants that do not comply with these policies.
 
VIII.  APPLICATION RECEIPT AND REVIEW SCHEDULE
 
Receipt        Initial         Advisory          Earliest
Date           Review          Council Review    Start Date
 
Nov. 15, 1991  February 1992     May 1992         July 1992
 
Applications received after the special receipt date of November 15,
1991, will not be eligible for FY 1992 funding under this RFA and will
be returned to the applicant.  Applicants may apply for research grants
on the prevention of alcohol-related problems among minorities under the
ongoing Alcohol Research Grant program announcement receipt dates of
February 1, June 1, and October 1 for future fiscal years.  Copies of
the regular Alcohol Research Grants program announcement (revised
January 1990) are available from the National Clearinghouse for Alcohol
and Drug Information, P.O. Box 2345, Rockville, Maryland 20852, or by
calling 301-468-2600 or toll free at 1-800-729-6686.
 
IX.  APPLICATION PROCESS
 
Applicants must use the grant application form PHS 398 (revised 10/88).
The number and title of this RFA, "AA-91-04, Research on the Prevention
of Alcohol-Related Problems Among Ethnic Minorities," must be typed in
item number 2 on the face page of the PHS 398 application form.
 
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.
 
Application kits containing the necessary forms and instructions may be
obtained from business offices or offices of sponsored research at most
universities, colleges, medical schools, and other major research
facilities.  If such a source is not available, the following office may
be contacted for the necessary application material:
 
National Clearinghouse for Alcohol and Drug Information
Post Office Box 2345
Rockville, MD  20852
Telephone:  (301) 468-2600 or 1-800-729-6686
 
The signed original and four permanent legible copies of the completed
application must be sent to:
 
Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**
 
In addition, it is requested that the applicant send two copies directly
to:
 
Office of Scientific Affairs
National Institute on Alcohol Abuse and Alcoholism
Parklawn Building, Room 16C-20
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-4375
 
X.  REVIEW PROCEDURES
 
The Division of Research Grants, NIH, serves as the central point for
receipt of applications under this RFA.  Applications received will be
assigned to an Initial Review Group (IRG) in accordance with established
Public Health Service Referral Guidelines.  The IRG, consisting
primarily of non-Federal scientific and technical experts, will review
applications for scientific and technical merit.  Notification of the
review recommendations will be sent to the applicant after the initial
review.  Applications will receive a second-level review by the National
Advisory Council on Alcohol Abuse and Alcoholism and the Advisory
Committee on Substance Abuse Prevention, where reviews may be based on
policy considerations as well as scientific merit considerations.  Only
applications recommended for approval by these advisory bodies will be
considered for funding.
 
XI.  REVIEW CRITERIA
 
Criteria to be used in the scientific and technical review of
applications will include the following:
 
  o  potential contribution of the proposed research to the scientific
     basis of programs for the prevention of alcohol-related problems
     among ethnic minorities;
 
  o  evidence that the investigators are familiar with the
     state-of-the-art knowledge in their proposed area of study;
 
  o  degree of scientific rigor in the design and implementation of the
     study;
 
  o  responsiveness to the issue of cultural sensitivity discussed in
     section V above;
 
  o  adequacy of the methodology proposed to collect and analyze data;
 
  o  qualifications and research experience of the Principal
     Investigator and other key research personnel;
 
  o  availability of adequate facilities, other resources, and
     collaborative arrangements necessary for the research;
 
  o  appropriateness of budget estimates for the proposed research
     activities;
 
  o  adequacy of provisions for the protection of human subjects; and
 
  o  adherence to the ADAMHA policy on inclusion of women in clinical
     study populations.
 
XII.  AWARD CRITERIA
 
Applications recommended for approval by the appropriate Advisory
Councils will be considered for funding on the basis of overall
scientific and technical merit of the application as determined by peer
review, NIAAA and OSAP program needs and balance, and the availability
of funds.
 
XIII.  TERMS AND CONDITIONS OF SUPPORT
 
Grant funds may be used for expenses clearly related and necessary to
carry out research projects, including direct costs that can be
specifically identified with the project and allowable indirect costs of
the institution.  Research grant support may not be used to establish,
add a component to, or operate a prevention, rehabilitation, or
treatment service program.  Support for research-related prevention,
rehabilitation, or treatment services and programs may be requested only
for costs required by the research.  These costs must be justified in
terms of research objectives, methods, and designs that promise to yield
generalizable knowledge and/or make a significant contribution to
theoretical concepts.
 
In order to expand a research project to more research sites or to
increase the number or complexity of the interventions to be tested,
applicants may wish to seek additional funding from public or private
agencies.  If the research budget is to be supplemented by funds from
sources other than NIAAA or OSAP, the application must provide
documentation of the availability of these funds.
 
XIV.  PERIOD AND MECHANISM OF SUPPORT
 
Applicants may request up to four years of support.  Research support
mechanisms are limited to research project grants (R01s).  Annual awards
will be made subject to availability of funds and progress achieved.  A
competing continuation (i.e., renewal) application may be submitted
before the end of an approved period of support to continue a project
under the regular Alcohol Research Grants program announcement.
 
XV.  AVAILABILITY OF FUNDS
 
This RFA is considered high priority by NIAAA and OSAP.  Applications
submitted in response to this RFA will compete for $800,000 in new grant
money that is expected to be made available for this purpose in fiscal
year 1992.  It is anticipated that three to five projects will be
supported.
 
XVI.  FINAL REPORT REQUIREMENTS
 
Grantees are expected to submit an original and two copies of the final
report of their project to NIAAA and OSAP within 90 days of the
project's termination.  The final report must contain at least the
following:
 
  o  a literature review;
 
  o  a clear statement of purpose and methodology;
 
  o  the findings of the project;
 
  o  an interpretation and discussion of those findings, including a
     clear exposition of their relevance to the prevention of
     alcohol-related problems and their implications for further
     research;
 
  o  a description of dissemination achieved or planned;
 
  o  a summary or abstract of the report.
 
XVII.  CONSULTATION AND FURTHER INFORMATION
 
Potential applicants are encouraged to seek preapplication consultation.
For information on preparing an application under this announcement,
please contact:
 
Elsie Taylor or Susan E. Martin
Prevention Research Branch
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
5600 Fishers Lane, Room 13C-23
Rockville, MD  20857
Telephone:  (301) 443-1677
 
For fiscal and administrative matters, contact:
 
Elsie Fleming
Chief, Management Review and Assistance Section
Grants Management Branch
National Institute on Alcohol Abuse and Alcoholism
Parklawn Building, Room 16-86
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-4703
 
This program is described in the Catalog of Federal Domestic Assistance
No. 93.273.  Applications submitted in response to this announcement are
not subject to the intergovernmental review requirements of Executive
Order 12372, as implemented through the Department of Health and Human
Services regulations at 45 CFR Part 100, and are not subject to Health
Systems Agency review.  Grants must be administered in accordance with
the PHS Grants Policy Statement (revised 10/1/90), which may be
available from your office of sponsored research.  Federal regulations
at Title 42 CFR Part 52, "Grants for Research Projects," and Title 45
CFR Parts 74 and 92, "Administration of Grants," are applicable to these
awards.
 
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