The National Institute on Minority Health and Health Disparities (NIMHD) is issuing this Notice of Special Interest (NOSI) to highlight the urgent need for research on the impact of the novel Coronavirus (SARS-CoV-2) pandemic causing COVID-19 disease outbreaks and the resulting disruptions on individual and social wellbeing, health services use, and health outcomes for NIH-designated health disparity populations.

Background
On March 13, 2020, the President of the United States declared a national emergency, including two declarations, one under the National Emergencies Act (NEA) and one under the Stafford Disaster Relief and Emergency Assistance Act in response to COVID-19. Multiple federal agencies are taking action to mitigate the impact of the disruption caused by the outbreak. Congress, State, and local governments are all mobilizing to deal with the pandemic and the impact of the outbreak across the nation. However, given the autonomy that state and local governments have in the federal system and in light of a wide-ranging background of existing local policies and resources, their actions and policies in response to this outbreak and its public health and economic impacts are varied.

The impact of COVID-19 outbreak has strained daily life for people living in the United States, affecting nearly every sector including healthcare, education, labor, transportation, finance, agriculture, housing, and cultural activities. However, the impact of the disruption on lives and livelihoods is likely to be greatest for health disparity populations who are at greater risk to experience inadequacies or insecurities in all these aforementioned sectors. These populations are also known to be disproportionately overrepresented in disrupted industries, inadequately insured for health care, and have fewer resources and wealth to weather the disruptions caused by this major public health emergency.

While many national policies have been enacted to deal with the impact of the COVID-19 outbreak, state and local governments have jurisdiction over local implementation. For example, Medicaid has federal legislation, but state implementation within the federal regulations can vary substantially by state in addition to whether and how states have enacted Medicaid expansion. Similarly, many labor laws when they exist, such as paid sick leave, paid family and medical leave, unemployment benefits, and worker’s compensation vary in state and local implementation. This variation also applies to Public Health Policies, Supplemental Nutrition Assistance Program (SNAP), Housing and Urban Development Policies, and Department of Education Policies. All these policies and laws and the variation across states and localities will impact health services use and health outcomes of health disparity populations.

Research Objectives

This NOSI is soliciting research in health disparity populations that -seeks to understand: 1) how state and local policies and initiatives mitigate or exacerbate disparities in health services use and health outcomes; 2) the role that community-level protective and resilience factors and interventions have in mitigating the effects of the sector disruptions that the COVID-19 outbreak causes; and 3) how behavioral and/or biological mechanisms may contribute to COVID-19 manifestations.

Outcomes of interest include, but are not limited to, the COVID-19 incidence, prevalence, and mortality rates in defined populations; substance abuse and mental health effects; impact on chronic conditions; effects on severe maternal morbidity and mortality; and influence on access, utilization, and quality of health care (including needed medical care, medical treatments, and access to prescription drugs).

Projects must include a focus on one or more NIH-designated populations that experience health disparities in the United States, which include racial and ethnic minority groups (Blacks or African Americans, Hispanics or Latinos, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders), less privileged socioeconomic status, sexual and gender minorities and underserved rural populations.

Possible research interests related to the COVID-19 outbreak include but are not limited to the following:

• Examine the effects of the COVID-19 outbreak on disparities in healthcare utilization and health outcomes among medically vulnerable populations such as institutionalized and non-institutionalized elderly; persons with chronic conditions, mental health and/or substance abuse disorders, complex medical needs, and/or with compromised immune system function; and pregnant women.
• Examine the effects of the COVID-19 outbreak on disparities in healthcare utilization and health outcomes among socially vulnerable populations such as the homeless, the recently incarcerated, immigrants, persons with disabilities, and children.
• Examine the effects of the COVID-19 outbreak on disparities in access to care and quality of care for health disparity populations, taking into account how it impacts the structure and organization of different health care systems that serve disparity populations, including those living in rural areas.
• Examine how clinician and health care system biases affect health and health care disparities in relation to the COVID-19 outbreak.
• Examine the effects of the COVID-19 outbreak on the health outcomes of the health care workforce serving health disparity populations and factors alleviating or exacerbating these outcomes.
• Examine the geographic and place-based variations in social contexts and their influence on minority health and/or health disparities in relation to the COVID-19 outbreak.
• Examine how racism and other types of discrimination at multiple levels (structural, institutional, and personally mediated) influence minority health and/or health disparities in relation to the COVID-19 outbreak.
• Examine the role of state and local policies in different sectors (e.g., healthcare, labor, transportation, housing) in exacerbating or reducing the impact of COVID-19 on minority health and health disparities.
• Examine the effectiveness of existing health and social justice practices (policies geared towards low income and marginalized communities) such as paid sick leave for low-income jobs, ensuring access to food and other necessities, placing moratoriums on evictions, and increasing affordable housing, to minimize the health, financial and social impacts of the outbreak for health disparity population(s).
• Examine the effectiveness of best practices in health communication and social marketing, including the role of social media, on health promotion and prevention in relation to COVID-19 in health disparity populations.
• Community engaged research studies examining community and culturally appropriate COVID-19 prevention methods.
• Modeling studies of the effects of the epidemic and the mitigation interventions on the health outcomes of health disparity populations including mental illness, substance use, exacerbation of chronic diseases and mortality.
• Examine how protective factors and factors that promote resilience at the individual, interpersonal, and contextual levels (e.g., social networks, and structural, neighborhood, and community resources) influence COVID-19 impact on minority health and/or health disparities.
• Documentation of COVID-19 natural history in an established health disparity study population.
• Examine the role of genetic susceptibility and differential biological pathways with COVID-19 disease severity in health disparity populations, including epigenetic effects associated with social and environmental exposures.
• Examine the influence of self-reported chronic stress and/or biological markers of chronic stress on minority health and/or health disparities in relation to the COVID-19 outbreak.
• Examine the role of social determinants of health and cognitive and behavioral factors in influencing preventive health behaviors and practices related to the COVID-19 outbreak that may influence minority health and health disparities.
• Examine novel behavioral interventions leveraging digital technology to promote adherence with hand washing, social distancing, and self-quarantine recommendations?.

The National Institute of Mental Health (NIMH)will accept and consider support for applications for supplements and revisions to NIMH projects that fall within the scope of this announcement and are relevant to the mission and strategic priorities of the NIMH. Applications to describe the epidemiology of mental disorders and symptoms related to the COVID-19 pandemic are not a high priority; applications to examine how a disrupted workforce may adequately respond/adapt to and maintain services or provide additional care for new or worsening mental health needs where we anticipate health disparities will be most prominent will be seen as a high priority.

The National Institute on Aging (NIA) will accept applications for supplements and revisions to NIA-supported projects that fall within the scope of this announcement and are relevant to the mission and strategic priorities of the NIA. Applications are encouraged that address the specific needs and circumstances of midlife and older adults, including, but not limited to, individuals with Mild Cognitive Impairment (MCI), Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD) and their healthcare providers and caregivers.

Application and Submission Information

Applications in response to this NOSI must be submitted using one of the following target opportunities or subsequent reissued equivalent.

• PA-18-591 Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional) is intended to provide funds for NIH grantees where the work proposed in the supplement is within the scope of the ongoing grant.
• PA-18-935 Urgent Competitive Revision to Existing NIH Grants and Cooperative Agreements (Urgent Supplement - Clinical Trial Optional) is intended to provide funds for NIH grantees applying to expand the scope of their active grant.
• The funding instrument, or activity code, will be the same as the parent award.

All instructions in the SF424 (R&R) Application Guide and in the target funding opportunity announcement (PA-18-591 or PA-18-935) must be followed, with the following additions:

• Individual requests can be no more than $125,000 in direct costs.
• The Research Strategy section of the application is limited to 6 pages.
• The project period will generally be limited to 1 year. Project periods up to 2 years will be considered only with strong justification.
• The parent award must be active when the supplement application is submitted (e.g. within the originally reviewed and approved project period), regardless of the time remaining on the current project.
• Applications will be accepted on a rolling basis from May 01, 2020 through May 01, 2021 by 5:00 PM local time of the applicant organization. This NOSI expires on May 02, 2021. An application submitted in response to this NOSI that is received on May 02, 2021 or later will be withdrawn.
• Specific to applications that target PA-18-591 (Administrative Supplements): The process for Streamlined Submissions using the eRA Commons cannot be used for PA-18-591.
• IMPORTANT: For funding consideration, all applicants must designate NOT-MD-20-019 in the Agency Routing Identifier field (Box 4b) of the SF424 (R&R) Form. Applications without this information in Box 4b will not be considered for this initiative.
• All applications (including those for multi-project activity codes) must be submitted electronically using a single-project application form package

  • Administrative supplement applications to PA-18-591 must use the application form package with the Competition ID that contains FORMS-E-ADMINSUPP . This FOA will be reissued with application form packages containing FORMS-F-ADMINSUPP on May 25, 2020. Submissions to PA-18-591 must be completed by June 25, 2020 (see NOT-OD-20-026 for details.) Submissions to the reissued FOA will be accepted on or after May 25, 2020 through the expiration date of this Notice.

  • Competitive revision applications to PA-18-935 must use the application form package with the Competition ID of NOT-MD-20-019-FORMS-E." This FOA will be reissued with a NOT-MD-20-019-FORMS-F package on May 25, 2020. Submissions to PA-18-935 must be completed by June 25, 2020. Submissions to the reissued FOA will be accepted on or after May 25, 2020 through the expiration date of this Notice.

Applications nonresponsive to terms of this NOSI will be not be considered for the NOSI initiative.

Investigators planning to submit an application in response to this NOSI are strongly encouraged to contact and discuss their proposed research/aims with Program staff listed on this NOSI well in advance of the application receipt date to better determine appropriateness and interest of the relevant Institute.