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The first draft did not follow instructions and therefore lead me to a failing grade. I will attach the comments my professor added to my paper as well as a sample paper for your reference.
This research is not by a sub agency of the NIH. This research is being proposed by you on behalf of your practicum site (which you are the director of extramural funding for). I encourage you to please read the lecture slides and instructions on the assignments. please also check out the resources tab on canvas that has sample grant proposals this section did not really cover any of the necessary information. in the statement of need, you were supposed to focus on explaining the research topic and why its important, explain how this research is new or innovative, highlight the gap in research this study is filling, and impact of the research. - - I am really confused with this project narrative. You don't seem to really have explained how you will conduct your research and did not mention any of the information you were supposed to here. This seems more like a literature review rather than a research proposal. You also did not address any of my feedback from last week. The focus of your project narrative was to explain how you will conduct your research. I am really confused here because it does not seem you read the instructions or understood the assignment :( Please be sure to read directions and email me if you need further clarification. Dear Christine, Thank you for reviewing and providing feedback for my grant proposal second draft! I am glad that you provided a lot of detailed feedback on how I can improve upon my paper. After reviewing your feedback, I made some more improvements to this grant proposal. The first area that I went over was grammar. You were able to catch my use of passive voice in some parts of the paper. Although they are well-written and structured, I made those changes and located areas where I utilized passive voice. Most of the comments in my paper were over minor details that I forgot to include in the paper. I added the dollar amount requested to the cover letter and also discussed how my proposal aligns with NIHMDI’s goals/mission. As suggested, I put the title of the study in the header. I also specified the type of study the proposal is on throughout the paper. For the data sharing section, I included further information on how the data will be shared and what criteria must be met by other researchers for access. I still needed to clarify the months for the timeline. I made some changes to make the timeline clearer. I also changed the verb tense to the future and added the frequency of follow-up visits required by the participants. For the conclusion, I added a clarifying sentence that suggests what future researchers should specifically focus on to build off of this study. Your final critique for my paper was the budget justification section. In the last draft, I briefly glossed over the personnel section in the last proposal. This time, I added a detailed breakdown to justify the personnel costs. I also added fringe benefits which is crucial to mention in the paper because that is $60,000 that I did not explain! There were only a few adjustments made to the paper and the integrity of it remains intact. After making the necessary revisions to my essay, I am confident that my grant proposal is stronger as a whole and focuses on the importance of the research study for at-risk minority stroke patients. Sincerely, SEARCH Lab 653 E. Peltason Drive, 3080 AIRB Irvine, CA 92617 23 February 2021 NIH Center for Scientific Review 6701 Rockledge Drive Room 1040-MSC 7710 Bethesda, MD 20817 To whom it may concern: I am pleased to submit a grant proposal with the title: “Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients with Stroke and Transient Ischemic Attack” for consideration under the NIH Research Grant Program (R01) with PA-20-184, as discussed with the Program Officer, Richard Berzom. I am requesting $714,224 towards this research study. Please assign this application to the following: • • Institutes/Centers o National Institute on Minority Health and Health Disparities Scientific Review Groups o Clinical Management in General Care Settings The project is in alignment with the mission of the National Institute on Minority Health and Health Disparities (NIMHD). NIMHD aims to seek knowledge that alleviates the burden of disease for minority groups. This new research study aligns with NIMHD’s mission by preventing recurrent stroke through improved discharge care for minorities. Through our research study, we plan to minimize health disparities amongst minority populations by finding innovative methods to prevent the onset of recurrent stroke incidence. The Clinical Management in General Care Settings (CMGC) Study Section reviews applications for studies on clinical management of patients from a medical provider perspective, including intent to guide care. The study aligns with CMGC as is aims to implement culturally-tailored educational discharge programs for minority stroke patients via rehabilitation and supportive care. Thank you very much for your consideration. Sincerely, Principal Investigator OMB Number: 4040-0001 Expiration Date: 12/31/2022 APPLICATION FOR FEDERAL ASSISTANCE 3. DATE RECEIVED BY STATE 1. TYPE OF SUBMISSION 4. a. Federal Identifier SF 424 (R&R) Pre-application Application 2. DATE SUBMITTED Changed/Corrected Application b. Agency Routing Identifier Applicant Identifier c. Previous Grants.gov Tracking ID February 23rd, 2021 5. APPLICANT INFORMATION Organizational DUNS: Susan and Henry Samueli College of Health Sciences Legal Name: Department: State Application Identifier Program in Public Health Division: SEARCH Lab 653 E. Peltason Drive, 3080 AIRB Street1: Street2: Irvine California City: State: County / Parish: Province: USA: United States of America Country: ZIP / Postal Code: 92617 Person to be contacted on matters involving this application Prefix: First Name: Sally Middle Name: Tamandua Last Name: Suffix: Director of Extramural Funding 653 E. Peltason Drive Position/Title: Street1: Street2: Irvine City: County / Parish: California State: Province: USA: United States of America Phone Number: 888-555-1212 ZIP / Postal Code: Country: Email: 92617 Fax Number: sally.tamandua@uci.edu 6. EMPLOYER IDENTIFICATION (EIN) or (TIN): 7. TYPE OF APPLICANT: H. Public/State Controlled Institution of Higher Education Other (Specify): Small Business Organization Type Women Owned 8. TYPE OF APPLICATION: New Renewal If Revision, mark appropriate box(es). Resubmission Continuation Socially and Economically Disadvantaged A. Increase Award Revision Is this application being submitted to other agencies? B. Decrease Award C. Increase Duration D. Decrease Duration E. Other (specify): Yes No What other Agencies? 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: TITLE: 9. NAME OF FEDERAL AGENCY: National Institute on Minority Health and Health Disparities 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients With Stroke and Transient Ischemic Attack 12. PROPOSED PROJECT: Start Date Ending Date 13. CONGRESSIONAL DISTRICT OF APPLICANT 03/2021 CA-45 12/2024 SF 424 (R&R) Page 2 APPLICATION FOR FEDERAL ASSISTANCE 14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: First Name: Middle Name: Drum Last Name: Organization Name: Department: Suffix: MPH Research Manager Position/Title: Street1: Emily Susan and Henry Samueli College of Health Sciences Program in Public Health Division: SEARCH Lab 653 E. Peltason Drive Street2: City: Irvine State: California County / Parish: Province: USA: United States of America Country: Phone Number: 704-860-1270 ZIP / Postal Code: 92617 92617 Fax Number: edrum@uci.edu Email: 15. ESTIMATED PROJECT FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Total Federal Funds Requested 714224 b. Total Non-Federal Funds 0 c. Total Federal & Non-Federal Funds 714224 d. Estimated Program Income 714224 THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: a. YES DATE: b. NO February 23rd, 2021 PROGRAM IS NOT COVERED BY E.O. 12372; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious. or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) I agree *The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Add Attachment Delete Attachment View Attachment 19. Authorized Representative First Name: Prefix: Last Name: Middle Name: Sally Suffix: Tamandua Position/Title: Director of Extramural Funding Organization: Susan and Henry Samueli College of Health Sciences Department: Program in Public Health Street1: 653 E. Peltason Drive Division: SEARCH Lab Street2: City: State: Country: California Province: ZIP / Postal Code: USA: United States of America Phone Number: Email: County / Parish: Irvine 888-555-1212 92617 Fax Number: sally.tamandua@uci.edu Date Signed Signature of Authorized Representative January 30th, 2021 20. Pre-application Add Attachment Delete Attachment View Attachment 21. Cover Letter Attachment Add Attachment Delete Attachment View Attachment 1 Project Summary Recurrent stroke incidents are on the rise in the United States, especially amongst the minority population. Patients who have experienced stroke are 30% more likely to have another stroke incident within five years. For minorities, the risks are higher. The high risk is due to socioeconomic and demographic factors such as lack of access to quality care, low health literacy, poor adherence to medical programs, etc. Hispanic and black patients are more than 2 to 3 times likely to experience a recurrent stroke incident than their white counterparts. Nevertheless, recurrent stroke incident is preventable. Many of the risk factors for stroke are modifiable (i.e. physical activity, diet, etc.) Hence, it is necessary to implement solutions that could ultimately benefit the minority population from further exposure or risk of stroke. The SEARCH Lab proposes a study that combats the risk of recurrent stroke amongst minority populations. From previous studies, it has been shown that increasing health literacy and minimizing modifiable risk factors through educational discharge programs could help with preventing recurrent stroke. However, it remains unclear whether these educational discharge programs can help minority populations specifically. The purpose of this experimental study is to see how minority stroke patients could benefit from a culturally-tailored educational discharge program in comparison to the standard discharge care. The study will utilize the same research framework as the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study conducted by Dr. Boden-Albala. Similar to the DESERVE study, we will be utilizing an experimental study design. To be able to generalize the effectiveness of this intervention for minority populations, minority stroke patients will be the only patients that are eligible to participate in the study. Participants in the study will be randomly assigned to either the culturally-tailored educational discharge program or standard discharge care. Through the 2 program, we will learn if there are significant improvements in systolic blood pressure between the two experimental groups. We hypothesize that the patients that receive the culturally-tailored educational discharge program will have lower systolic blood pressure than their control group counterparts. There are two aims for this study: Aim 1: Discover the benefit and significance of educational discharge care for stroke patients, Aim 2: Discover the benefit of culturally-tailored interventions for minority groups. Following the findings of the study, we will disseminate the information to further research on preventative medicine and stroke rehabilitation through educational interventions. Public Health Significance Most stroke patients receive a basic standard discharge care that fails to educate patients on how to manage their condition and prevent another incidence of stroke, yet this could be managed through an educational intervention. The DESERVE framework utilizes a culturallytailored educational discharge program that aims to increase health literacy and awareness amongst minority patients who are at risk of a recurrent stroke incident. This study will contribute to longstanding improvements in creating innovative interventions that aim to prevent the risk of disease and help enhance and lengthen the lives of all stroke survivors across the United States. 3 Organization Information The Social Epidemiology and Research in Community Health (SEARCH) lab focuses on stroke, chronic disease and risk factors, and COVID-19. Our mission is to prevent disease by conducting social epidemiological research and utilizing demographic information to explore risk factors for disease. Social epidemiology is a field of study that investigates how one’s surroundings can interact and prevent disease. We have conducted research studies on educational discharge interventions for stroke and research which effective health communication models could minimize vaccine-hesitancy towards the COVID-19 vaccine. To support the mission of the organization, we study existing literature and collect social demographic information that is relevant to the diseases of study. The research work and findings that the SEARCH Lab has done on COVID-19 will benefit the elderly patients who are eligible for CalOptima. This demographic is most vulnerable to the effects of this infectious disease. SEARCH creates informational pamphlets and educational resources to disseminate the knowledge to the public. It is vital to share important information about COVID-19 and the vaccine to increase health literacy and diminish vaccine hesitancy. This lab supports the research of Dean Bernadette Boden-Albala. Dr. Boden-Albala is an internationally recognized researcher in the social epidemiology of stroke and cardiovascular disease. Graduate students, research assistants, and undergraduate interns are involved in the research team. The SEARCH Lab is also dedicated to analyzing how social determinants play a role in the development of non-communicable diseases. It has pushed efforts to better understand the effectiveness of community-level assessments and interventions, especially for stroke prevention. The current studies on the DESERVE intervention framework inform how culturally tailored educational discharge programs could prevent recurrent stroke. 4 Statement of Need/Objective According to a stroke study conducted in 2014, approximately 200,000 of the 800,000 stroke events are recurrent stroke incidents (Go et. al, 2014). Recurrent stroke events are more fatal than incident strokes. Not only are they more physically debilitating, but they also contribute to high financial burdens for the patient and their families. These recurrent stroke incidents are especially common amongst non-white minority populations. In comparison to their white counterparts, racial and ethnic minority groups are at higher risk of another recurrent stroke event (Evans-Hudnall et. al, 2014). Non-communicable diseases are a common phenomenon amongst minority groups due to health disparities. Most patients that fall within these groups come from socioeconomically disadvantaged backgrounds (Padilla et. al, 2019). Stroke is no exception to increased risk due to poor socioeconomic factors. Minority-identifying patients have less access to care, less knowledge about managing their disease, and a lack of awareness of stroke-related risk factors (Cruz-Flores et. al, 2011). Minorities need additional support beyond standard discharge care because of their increased vulnerability to a recurring stroke incident. Overall, there is a gap in terms of proper care for stroke patients in racial and ethnic minority groups. Recent studies have been conducted to test the effectiveness of an educational intervention that addresses the health disparities for stroke patients. Previous studies have shown that a low-cost peer education self-management workshop can improve blood pressure among stroke and transient ischemic attack survivors (Kronish et. al, 2014). Educational interventions main aim is to increase health literacy and encourage patients to adopt healthy behaviors. Social and behavioral interventions that are education-focused are especially effective for recurrent stroke prevention. Stroke is often caused by modifiable risk factors such as smoking, physical 5 inactivity, and poor diet (Furie et. al, 2011). Current behavioral interventions target these modifiable risk factors to lower the risk of a recurrent stroke incident. Despite the educational intervention’s proven success in previous studies, several missing mechanisms limit the effectiveness of reducing the likelihood of recurrent stroke. Current studies lack the ability to address specific cultural barriers for minority groups (Salinas and Schwamm, 2017). There is a need to understand the common socio-cultural barriers in order to see improvement in blood pressure for minority stroke patients. Hence, a culturally-tailored educational discharge program could lead to better results in reducing high levels of systolic blood pressure. The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention delivers a culturally-tailored educational program that educates stroke patients on best practices for managing their condition to address the socio-cultural barriers. The DESERVE intervention has proven to be effective in lowering systolic blood pressure amongst Hispanic populations, but there has not been enough research on ethnic minority populations to generalize the efficacy of the intervention for all minorities. This experimental study proposal will integrate a larger sample size of minorityidentifying stroke patients from larger metropolitan cities across the United States to gauge the efficacy of the educational discharge program. Minorities in the United States suffer from a higher risk of recurrent stroke events because of their lack of awareness and education on adopting behaviors to keep their systolic blood pressure at a healthy level. This study differs from previous studies as it collects data on the target minority population. Through improved data collection, the study can provide a better understanding of what prevention efforts need to be implemented in order to cater to this vulnerable population (Weissman and Hanain-Wynai, 2011). This proposal will contribute to the advancement of preventative medical care. 6 Project Description Hypothesis and Specific Aims The objective of this mixed-methods study is to understand if an educational discharge stroke intervention can reduce rates of recurrent stroke incidences in comparison to the standard discharge care. Aim 1 of this study is to find out if stroke patients benefit from educational discharge care. In conjunction, Hypothesis 1 is that educational discharge stroke care will lead to lower risk or recurrent stroke than the standard quality of discharge care. Patients undergoing the educational discharge intervention will have lower systolic pressure in comparison to the patients in the control group with the standard discharge care. This study also aims to discover whether racial minority groups could benefit from a culturally-tailored intervention. Hypothesis 2 is that a culturally-tailored educational program will benefit ethnic/racial minorities by increasing medication adherence, lowering blood pressure, and advancing health literacy. Overall, this study aims to assess whether an educational discharge program has a high level of efficacy to minimize the likelihood of a recurrent stroke incident amongst minority groups. Methods Study Design This study will be a randomized controlled trial (RCT), an experimental study design. The intervention group is assigned the culturally-tailored educational program. The control group is assigned the standard discharge care. Participants will receive a request for a follow-up one year after their recruitment in the study. Sample Selection 7 Minority stroke patients will be invited to participate in the study. In order to select eligible participants, the study will be utilizing criterion sampling. Criterion sampling is particularly useful in mixed-method studies that aim to select participants who satisfy the criteria (Palinkas et. al, 2013). The inclusion criteria are that the patient must be over 18 years of age, have one or more vascular risk factors (hypertension, smoking, etc.), and have enrolled as a patient with a stroke incident. In contrast, the exclusion criteria are dementia, being in a nursing home, and a terminal illness with a life expectancy of less than one year (Lord et. al, 2015). A total of 2,000 participants will be randomized to receive the intervention or usual care. All participants in the study must provide written informed consent to participate. The sample will be selected from two geographic locations that are populated with ethnic minorities, New York and Los Angeles. Each geographic location will recruit 1,000 individuals who experience a stroke-related incident. The patients are randomized into the intervention or control group through a computerized permuted block randomization program. To incentivize the individuals to participate, a hundred $50 gift cards will be raffled off for the study. Data Collection The independent variables are the changes to the different methods of stroke discharge care. The dependent variables are the changes in blood pressure. This research study is yearlong. If the patient agrees to participate in the study, their full medical history, demographics, and blood pressure will be recorded for the study. The blood pressure will be measured with an automatic sphygmomanometer, adhering to the American Heart Association Guidelines (Pickering et. al, 2005). After the initial measure of blood pressure, participants are invited to come back and get their blood pressure measured once again a year after the baseline assessment. Research assistants will be recruited and trained to assist with the study. Trained research 8 assistants would administer surveys to the participants in addition to following the standard protocol for measuring systolic blood pressure. The research assistants are blind to the intervention status of the patient. If participants cannot come in for a one-year follow-up, research assistants will ask for permission to have access to their recent medical information with their physician. In addition to the quantitative aspect of blood pressure levels, there is a qualitative element to this study. Patients will be measured on their confidence in managing their hypertension condition through a survey administered at the start and the end of the study. The researchers can better explain in which ways the intervention could minimize the risk of recurrent stroke by utilizing t-test for comparison. Data Analysis The data is analyzed by comparing the change in systolic blood pressure between the interventions. To test the effectiveness by racial group, the study stratifies all analyses by racial/ethnic identification. Within the intervention group, the study will examine whether there was a dose-response relationship by comparing the mean reduction in systolic blood pressure by number of calls with t-tests and analysis of variance (Boden-Albala et. al, 2019). The program the research study will utilize for the project is STATA. Additionally, the study will utilize the survey responses to draw conclusions on improvements in health literacy and adoption of healthy behaviors following completion of the intervention study. Ethics This study will be using human subjects and collecting sensitive health information. Without informed written consent, patients will not be qualified to participate in the study. All collected sensitive health information will not include any identifiers and the participants’ 9 information will be kept completely confidential. Instead, a participant ID number will be assigned to keep the names and information anonymous. Patients will be made aware that their medical information will be collected if they do not attend the follow-up study. Participants are free to withdraw from the study at any time. Before conducting the study, the research team plans on receiving IRB approval to ensure the safety of the human subjects. Data Sharing All information collected for this study will be shared with a national database because it censors any identifying medical information. Other researchers must fill out a data-sharing agreement form to access the data and follows the same rules of adhering to patient confidentiality. To maintain patient confidentiality, all identifying information will not be published in the study as it is irrelevant to the study’s aims. Timeline This study will be completed in three years with a projected end date of December 2024. Starting in March 2021, the research team will be seeking IRB approval, recruit eligible stroke patients from major hospitals in the target cities, and train research assistants for data collection. After June 2021, the team will gather the patients’ demographic and medical information until March 2022. By March 2022, the patients will be randomized into the control and intervention groups. From March 2022 to March 2023, the participants will be exposed to their designated care program. Between March to June of 2023, participants will be invited for a one-time followup data collection to get their blood pressure measured and survey responses recorded. From June to December of 2023, the data will be recorded, cleaned, and sorted for analysis. The research team will analyze the research findings from the data collection and work on the study 10 for final publication for the remainder of the time. SEARCH Lab’s projected date of submission for publication and presentation will fall on December 2024. Conclusion Recurrent stroke incidents are a pressing problem for the minority stroke patient population. Rates of stroke incidences are much higher in racial and ethnic minority groups because of their low socioeconomic status, lack of awareness on stroke prevention, and lack of access to quality care. Due to the increasing rates of recurrent strokes amongst this vulnerable population, further studies on interventions that address these issues must be done. Current studies on stroke prevention have only focused on the general population. However, those at higher risk of a recurrent stroke event are black or Hispanic. To minimize the rates of recurrent stroke, stroke patients should undergo an educational intervention to be aware of modifiable risk factors related to stroke and opt to adopt healthy behaviors. The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention directly addresses the areas in need of improvement to serve the patients that belong in minority groups. This proposed study will focus on non-white racial groups to determine the efficacy of the “culturally-tailored” portion of the educational discharge intervention. It is expected that minority patients will face a lower risk of recurrent stroke after exposure to the culturally-tailored educational discharge program. There is a need for the implementation of culturally-tailored educational discharge programs to address these health disparities among minorities. The goal of the study is to set the foundation for further research in the field of preventative medicine and stroke rehabilitation care to lower the risk of recurrent stroke incidence amongst the minority population. Future researchers can focus more specifically on employing other educational interventions to minimize health disparities among minority groups. 11 Bibliography Boden-Albala, B., Goldmann, E., Parikh, N. S., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeier, J., Parides, M., & Quarles, L. (2019). Efficacy of a discharge educational strategy vs standard discharge care on reduction of vascular risk in patients with stroke and transient ischemic attack. JAMA Neurology, 76(1), 20. https://doi.org/10.1001/jamaneurol.2018.2926 Cruz-Flores, S., Rabinstein, A., Biller, J., Elkind, M. S. V., Griffith, P., Gorelick, P. B., Howard, G., Leira, E. C., Morgenstern, L. B., Ovbiagele, B., Peterson, E., Rosamond, W., Trimble, B., & Valderrama, A. L. (2011). Racial-Ethnic Disparities in Stroke Care: The American Experience. Stroke, 42(7), 2091–2116. https://doi.org/10.1161/STR.0b013e3182213e24 Evans-Hudnall, G. L., Stanley, M. A., Clark, A. N., Bush, A. L., Resnicow, K., Liu, Y., Kass, J. S., & Sander, A. M. (2014). Improving secondary stroke self-care among underserved ethnic minority individuals: A randomized clinical trial of a pilot intervention. Journal of Behavioral Medicine, 37(2), 196–204. https://doi.org/10.1007/s10865-012-9469-2 Furie, K. L., Kasner, S. E., Adams, R. J., Albers, G. W., Bush, R. L., Fagan, S. C., Halperin, J. L., Johnston, S. C., Katzan, I., Kernan, W. N., Mitchell, P. H., Ovbiagele, B., Palesch, Y. Y., Sacco, R. L., Schwamm, L. H., Wassertheil-Smoller, S., Turan, T. N., & Wentworth, D. (2011). Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. Stroke, 42(1), 227–276. https://doi.org/10.1161/STR.0b013e3181f7d043 Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., Dai, S., 12 Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Kittner, S. J., … Turner, M. B. (2014). Executive Summary: Heart Disease and Stroke Statistics—2014 Update. Circulation, 129(3), 399–410. https://doi.org/10.1161/01.cir.0000442015.53336.12 Kronish, I. M., Goldfinger, J. Z., Negron, R., Fei, K., Tuhrim, S., Arniella, G., & Horowitz, C. R. (2014). Effect of Peer Education on Stroke Prevention. Stroke, 45(11), 3330–3336. https://doi.org/10.1161/STROKEAHA.114.006623 Lord, A. S., Carman, H. M., Roberts, E. T., Torrico, V., Goldmann, E., Ishida, K., Tuhrim, S., Stillman, J., Quarles, L. W., & Boden-Albala, B. (2015). Discharge educational strategies for reduction of vascular events (DESERVE): Design and methods. International Journal of Stroke, 10(A100), 151–154. https://doi.org/10.1111/ijs.12571 Padilla, C., Grimaud, O., Nowak, E., & Timsit, S. (2019). Neighborhood disparities in stroke and socioeconomic, urban-rural factors using stroke registry. European Journal of Public Health, 29(Supplement_4). https://doi.org/10.1093/eurpub/ckz187.132 Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2013). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544. https://doi.org/10.1007/s10488-013-0528-y Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005). Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Circulation, 111(5), 697–716. https://doi.org/10.1161/01.CIR.0000154900.76284.F6 13 Salinas, J., & Schwamm, L. H. (2017). Behavioral Interventions for Stroke Prevention. Stroke, 48(6), 1706–1714. https://doi.org/10.1161/STROKEAHA.117.015909 Weissman, J. S., & Hasnain-Wynia, R. (2011). Advancing health care equity through improved data collection. New England Journal of Medicine, 364(24), 2276- 2277. https://doi.org/10.1056/nejmp1103069 14 Budget Justification To ensure the success of this study, funding is needed to execute the data collection and analysis of the results. The primary source of data collection from the participants is the sphygmomanometer which costs $100 for four units. To ensure the security of the collected data, a work laptop will be utilized by all members of the research team and dedicated to this project alone. With six people on the team, laptops will cost a total of $1800 for six units. A statistical analysis tool (STATA) will be installed which costs $48/unit, totaling $1,288. To incentivize the patients to partake in the study, $5000 will be allocated to 100 $50 gift cards that will be raffled off to the patients. The study will be taking place in two different locations – New York City and Los Angeles. Since UCI Public Health is close to Los Angeles, travel expenses will only be allocated to New York City. The travel expenses consist of flight tickets ($130/ticket) and airbnb ($600/week). The entire team of six will fly to New York twice a year for the first two years of the study. This is to collect data in New York City and interact with the hospital in order to implement the educational discharge program. The total expenses for the travel costs will equate to $3,960 for two years. In addition to the other expenses towards data collection, there is a need for basic office and printing supplies. Paper surveys will be administered to each participant, so $500 will be set aside towards basic printing and office costs. Since New York is far from the SEARCH Lab, a facility will need to be rented to conduct the data collection off-site. Finally, to ensure that the study is successfully completed, an overhead expense of $255,000 for the salary of all members of the research team. The salary requested will be the market salary for one PI, one post-doc, and four graduate students. Each will be rewarded $10,000 in fringe benefits which equate to the grand total will be $315,000 for personnel costs. Overall, the request to successfully conduct this research study is $714,224. Program Director/Principal Investigator (Last, First, Middle): Tamandua, Sally DETAILED BUDGET FOR INITIAL BUDGET PERIOD DIRECT COSTS ONLY FROM THROUGH 03/2021 12/2024 List PERSONNEL (Applicant organization only) Use Cal, Acad, or Summer to Enter Months Devoted to Project Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits ROLE ON PROJECT NAME Cal. Mnths Acad. Mnths Summer INST.BASE Mnths SALARY SALARY REQUESTED FRINGE BENEFITS TOTAL PD/PI 0 0 0 100,000 100000 10000 110000 Post Doc Student Post Doc Student 0 0 0 55,000 55000 10000 65000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 Graduate Student Graduate Student 0 0 0 25,000 25000 10000 35000 255000 60000 315000 Tamandua, Sally SUBTOTALS CONSULTANT COSTS N/A 0 EQUIPMENT (Itemize) Sphygmomanometer ($25/item -- 4 units), Laptop ($300/item -- 6 units) 1900 SUPPLIES (Itemize by category) Paper ($50), Printing ($150), Office Supplies ($300) 500 TRAVEL New York Flight ($130/ticket -- 6 tickets), Airbnb ($600/week -- 2 weeks) INPATIENT CARE COSTS 1980 0 0 N/A N/A OUTPATIENT CARE COSTS ALTERATIONS AND RENOVATIONS (Itemize by category) N/A 0 OTHER EXPENSES (Itemize by category) STATA ($48/unit -- 6 people), Gift Card Raffle ($50 -- 100 units) 5288 CONSORTIUM/CONTRACTUAL COSTS DIRECT COSTS SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page) $ FACILITIES AND ADMINISTRATIVE COSTS CONSORTIUM/CONTRACTUAL COSTS TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD PHS 398 (Rev. 01/18 Approved Through 03/31/2020) 0 Page 324668 500 $ 325168 OMB No. 0925-0001 Form Page 4 Program Director/Principal Investigator (Last, First, Middle): Tamandua, Sally BUDGET FOR ENTIRE PROPOSED PROJECT PERIOD DIRECT COSTS ONLY BUDGET CATEGORY TOTALS PERSONNEL: Salary and fringe benefits. Applicant organization only. INITIAL BUDGET PERIOD (from Form Page 4) 2nd ADDITIONAL YEAR OF SUPPORT REQUESTED 3rd ADDITIONAL 4th ADDITIONAL 5th ADDITIONAL YEAR OF SUPPORT YEAR OF SUPPORT YEAR OF SUPPORT REQUESTED REQUESTED REQUESTED 315000 315000 75000 0 0 0 1900 0 0 500 0 0 1980 1980 0 INPATIENT CARE COSTS 0 0 0 OUTPATIENT CARE COSTS 0 0 0 ALTERATIONS AND RENOVATIONS 0 0 0 OTHER EXPENSES 1288 288 288 0 0 0 320668 317268 75288 500 500 0 321168 317768 75288 CONSULTANT COSTS EQUIPMENT SUPPLIES TRAVEL DIRECT CONSORTIUM/ CONTRACTUAL COSTS SUBTOTAL DIRECT COSTS (Sum = Item 8a, Face Page) F&A CONSORTIUM/ CONTRACTUAL COSTS TOTAL DIRECT COSTS TOTAL DIRECT COSTS FOR ENTIRE PROPOSED PROJECT PERIOD 0 0 0 0 $ 714224 JUSTIFICATION. Follow the budget justification instructions exactly. Use continuation pages as needed. PHS 398 (Rev. 01/18 Approved Through 03/31/2020) Page OMB No. 0925-0001 Form Page 5 Study Record: PHS Human Subjects and Clinical Trials Information OMB Number: 0925-0001 Expiration Date: 03/31/2020 * Always required field Section 1 - Basic Information 1.1. * Study Title (each study title must be unique) Efficacy of Discharge Educational Strategy for Reduction of Vascular Risk in Minority Patients with Stroke and Transient Ischemic Attack Yes 1.2. * Is this Study Exempt from Federal Regulations? 1 1.3. Exemption Number No 2 3 4 5 6 7 8 1.4. * Clinical Trial Questionnaire If the answers to all four questions below are yes, this study meets the definition of a Clinical Trial. 1.4.a. Does the study involve human participants? 1.4.b. Are the participants prospectively assigned to an intervention? 1.4.c. Is the study designed to evaluate the effect of the intervention on the participants? 1.4.d. Is the effect that will be evaluated a health-related biomedical or behavioral outcome? 1.5. Provide the ClinicalTrials.gov Identifier (e.g., NCT87654321) for this trial, if applicable ? ? ? ? Yes No Yes No Yes No Yes No N/A Section 2 - Study Population Characteristics 2.1. Conditions or Focus of Study See "Hypothesis and Specific Aims" of Project Description 2.2. Eligibility Criteria See "Sample Selection" of Project Description 2.3. Age Limits Minimum Age 18 Years Maximum Age 80 Years 2.4. Inclusion of Women, Minorities, and Children See "Sample Selection" of Project Description 2.5. Recruitment and Retention Plan See "Sample Selection" of Project Description 2.6. Recruitment Status Not yet recruiting 2.7. Study Timeline See "Timeline" of Project Description 2.8. Enrollment of First Subject 03/30/2021 Anticipated Inclusion Enrollment Report(s) * Fellowship (F) and Career Development (K) applications to FOAs that do not allow clinical trials cannot propose independent clinical trial studies led by applicant PD/PI. However, proposing studies under the leadership of a sponsor/mentor that allows for clinical trials research experience is encouraged. Such studies must include HS information, but will receive a system error if information is included in CT study fields in sections 4 or 5 of form. Updated: December 21, 2017 FORMS-E Series Page 12 of 36 Grant Proposal First Draft Anthony Yacoub University of California, Irvine Public Health 195W Professor Gideonse 4 May 2021 Organizational Information The National Institute of Dental and Craniofacial Research (NIDCR) has a mission to improve oral, dental, and craniofacial health based on its research, training, and intervention programs. The institute aims to accomplish this mission by supporting clinical research on oral hygiene and conducting and funding research training that enables career development. Furthermore, the research institute coordinates and assists in relevant research and related activities in all sectors of community research and promotes transferring knowledge from the study conducted, including its implications on public health, health professionals, policymakers, and researchers (NIH, 2020). NIDCR launched its 2030 goal in 2017. It envisioned an initiative to imagine a future where most of the population understood dental, oral, and craniofacial health and its context on how these aspects impacted an individual's overall health. Besides, this initiative aims to promote health, treat oral-related diseases, and propose overcoming health disparities. Because of the necessity of this intervention program, NIDCR seeks help to develop and fund the 2020-2025 strategic plan (NIH, 2020). This strategic plan will guide the funding for the institute for the next half-decade. In this case, strategic planning involves establishing priorities, setting straightforward goals, and detailing the actions necessary to achieve set goals (NIH, 2020). The NIDCR plan consists of focusing resources and energy on attaining common set goals with agreed outcomes. NIDCR established five priority sections for the strategic plan, including oral and overall health, precision oral health, regenerative medicine, health disparities, and a diverse workforce (NIH, 2020). The institute also released a Request for Information (RFI) to solicit feedback on these priority sectors to create an initiative to help accomplish the objectives. Statement of Need Oral hygiene begins with having clean teeth, having an awareness of daily habits, and having proper dental care routines. Therefore, oral health care is significant because it lowers the risk of developing diseases such as cavities, periodontal disease, gingivitis, cracked tooth syndrome, bruxism-related conditions, among others (Coseo, 2020). Healthy oral practices allow individuals to smell better, taste, chew, swallow, speak, and smile confidently. Numerous oral conditions affect both children and adults. While some situations may be minor, others can be significantly serious and result in health complications with time. Some of these conditions include (WHO, 2020); · Bruxism- this condition causes excessive teeth grinding, especially when asleep. · Bad breath- also known as halitosis, this condition is characterized by chronic bad breath. · Dry mouth is a condition where salivary glands do not produce enough saliva and are also known as xerostomia. · Toothaches- this condition is characterized by pain near or in a tooth and is typically a consequence of tooth decay or abscess. · Cracked teeth- this condition involves having minor to severe cracks in teeth often caused by bruxism, an injury, among other factors. · Tooth sensitivity- this condition involves a tooth being sensitive to hot, cold, or sweet substances · Temporomandibular Joint Dysfunction- this condition causes significant pain in the jaws. · Mouth Breathing- this condition results in an individual regularly breathing through their mouth in their sleep. · Gum recession- this condition is where gums begin to pull back from the teeth, which exposes the tooth or the root of the tooth. · Burning mouth- this condition is a consistent burning or tingling sensation in the mouth. · Gingival Hyperplasia- this condition is the overgrowth of the gum tissue around the teeth. Furthermore, there are various oral diseases. Oral diseases are considerably more severe than oral conditions, where when left untreated, they can cause tooth loss or permanent damage to the surrounding areas. Some of the oral diseases include (WHO, 2020); · Gingivitis- this disease is an irreversible minor gum disease. · Periodontal disease- a severe gum disease that often results in permanent loss of bone. · Cavities- this disease is tooth decay, whether minor or significant. · Oral thrush- this disease is a yeast infection of the mouth. · Dental Abscess- a pocket of pus in a tooth. · Oral cancer- a form of cancer affecting the mouth or throat. Excessive alcohol consumption, tobacco use, and unhealthy eating habits can cause oral health to deteriorate over time. While general health conditions can typically worsen existing oral health situations, poor oral hygiene has been a risk factor for several issues. One of the risk factors of poor oral health is heart disease. Diseases such as gingivitis, when left untreated, become periodontal disease. This gum disease links to increased rates of cardiovascular disease because bad oral hygiene increases the risk of developing a bacterial infection that can reach the bloodstream and spread to the heart valves (Coseo, 2020). Furthermore, with untreated oral diseases, individuals risk developing chronic diseases such as diabetes or increasing the risk of getting a stroke with age. Poor dental hygiene also results in a weakened immune system, which increases the probability of developing infections, illnesses, and diseases. Therefore, because of the adverse effects of neglected oral health, this proposal by the NIDCR is necessary to create awareness on matters of oral hygiene and its impacts on individuals, families, and the community. Project Description According to WHO (2021), the threat of non-communicable diseases and the need to provide urgent and efficient public health responses led to the formulation of a global strategy to control and prevent these diseases. Similarly, the NIDCR aims to create designs for intervention on oral health and oral diseases. The institute will prioritize diseases linked by common, preventable, and lifestyle-related risk factors such as tobacco use or unhealthy diet. There is a relatively high risk of oral disease relating to socio-cultural determinants, including low income, low education levels, beliefs, and culture supporting oral health. According to Mejia et al. (2018), socioeconomic status has long been an area of interest in its effect on oral health. A majority of the evidence indicates that socioeconomic inequalities are typically associated with oral health status, both subjectively and objectively (Mejia et al., 2018). Therefore, it is necessary to monitor social inequalities and disparities in oral health to provide information on the differences populations face, their oral hygiene needs, oral health priorities, and preventive practices. Besides, previous studies demonstrate that socioeconomic positioning is negatively associated with oral health and dental diseases. The higher the income a family has, the better equipped they are to have information and experience fewer oral hygiene and dental conditions. In addition, education and income become significantly relevant indicators used in the epidemiology for socioeconomic status measurement, according to Mejia et al. (2018). Oral health counts as a constituent of general health, relying on subjective perceptions, while disease measurement utilizes objective indicators. Also, communities or regions with irregular exposure to fluorides are at an increased risk of dental cavities. At the same time, the settings with poor access to safe drinking water or sanitary facilities pose environmental risk factors to both oral and general health (S & M, 2021). Also, controlling oral diseases significantly depends on the accessibility and availability of oral health systems. However, reducing risks to oral disease is only plausible if there is an orientation of services towards prevention. Further to the socio-environmental aspects, this model emphasizes the role of intermediate and modifiable risk behaviors such as oral health practices, diet, and alcohol and substance use (S & M, 2021). These behaviors may affect not only the overall oral hygiene of individuals but also their quality of life. Clinical and public health research indicates that individual, professional, and community preventive measures are efficient in preventing oral diseases (WHO, 2021). However, the optimal intervention measures for oral diseases are not available universally, nor is it affordable because of the costs associated with dental health and limited resources. Coupled with the lack of emphasis on primary prevention measures for oral diseases, there is a significant challenge for many communities, especially for communities in low-income settlements that cannot access such services. A considerable portion of the evidence relates to preventing dental cavities and controlling periodontal diseases (WHO, 2021). Prevention of gingivitis is possible using proper oral hygiene practices, including regular brushing and flossing. These procedures are also valuable for controlling periodontal lesions, according to WHO (2021). Furthermore, an initiative such as community water fluoridation is an effective method of preventing dental cavities for adults and children. Water fluoridation works to benefit the community in its entirety by supplying water regardless of socioeconomic status. Milk and salt fluoridation schemes also have similar effects on dental health when used as preventive programs for communities. Therefore, both individual and professional measures such as fluoride mouth rinses, gels, kinds of toothpaste, and use of dental sealants are additional methods of prevention of dental cavities (Oberoi et al., 2016). In several communities, poor income communities, the introduction of fluoridated toothpaste has been a valuable strategy, which has ensured that individuals remain appropriately exposed to fluorides. Therefore, individuals can take personal actions for themselves and their families to prevent dental diseases and maintain hygiene. Combined with proper nutrition and diet, the primary prevention of most oral, dental, and craniofacial diseases is achievable. Lifestyle habits such as tobacco use, poor dietary choices, and excessive alcohol consumption affect dental hygiene and have significant effects on general health. Such behaviors are also associated with an increased risk of congenital craniofacial disabilities, periodontal diseases, dental cavities, oral candidiasis, pharyngeal cancers, among others (Oberoi et al., 2016). Also, opportunities exist to further expand the prevention of oral disease and promote health information and practices to the public using community programs and healthcare settings (WHO, 2021). As oral health care providers, the institute plays a significant role in promoting healthy lifestyles by incorporating tobacco cessation programs and utilizing nutrition counseling in daily practices (WHO, 2021). However, there exist some essential oral health disparities across various regions. These disparities typically relate to socioeconomic status, ethnicity, and race, age, gender, or in some cases, the status of general health, according to WHO (2021). While specific dental diseases are preventable, there is evidence that not all community members are adequately informed or are in a position to benefit from measures for appropriate health promotion. In this instance, the underserved communities and populations are evident in both developed and developing countries. However, in most countries, oral healthcare lacks full integration into the community and national programs, according to WHO (2021). The strategies for intervention for oral health care involve utilizing intervention tools to increase awareness about oral diseases and conditions and promote oral health habits among community members (Mo Gov, 2021). NIDCR aims to use campaigns and promotions on media outlets such as television and radio, and other modes of communication, including issuing brochures with intervention messages. Furthermore, with public figures or celebrity figures, the institute can endorse oral hygiene, diseases, conditions, and treatment options. Therefore, the institute must utilize consistent messages across these various communication channels to ensure the public remains aware. According to Mo Gov (2021), these oral health campaigns and promotions can increase awareness of the health risks of oral diseases and conditions and highlight their association with other health conditions. Furthermore, these campaigns aim to promote behavioral changes, reduce the risk of oral infections and diseases, and improve the knowledge and skills related to the benefits or challenges of proper habits for dental care. These campaigns also aim to change community norms by encouraging protective mouth gear for sports, reducing sugar and alcohol consumption, and ceasing tobacco use. The significant challenges of the future of this intervention program will exist in translating knowledge and experiences about the prevention of oral diseases into actionable programs. The social, economic, and cultural factors and the shifting population demographics rely significantly on delivering oral health services and how individuals care for themselves and their families. Therefore, reducing the disparities requires a wide range of approaches that target the high-risk populations for particular oral diseases and improve their access to proper care. Meanwhile, the most significant challenge for communities in low-income areas is offering oral health care within the context of primary health programs. These programs aim to meet the basic health needs of these populations, improve active outreach to the community, facilitate primary care, and pursue effective referral of patients, according to WHO (2021). Therefore, for these interventions to be available for communities in the United States, the existing partnerships require strengthening, especially with non-profit organizations. This participation of numerous organizations includes collaborating, encouraging community participation, creating policies towards oral health care reforms, and developing strategies for oral disease control in communities. Conclusion To sum up, oral health is a significant issue in the community that requires addressing. The NIDCR aims to facilitate intervention programs aimed at reducing oral health conditions and diseases in communities. These interventions need reforms of oral health systems to change the focus from invasive treatment options and towards prevention and use of minor treatments. The NIDCR identified various strategies for improving oral health, focusing on low-income and marginalized communities who have challenges accessing oral care. These strategies include population-wide prevention measures that are cost-effective and having patient-centered primary care. The NIDCR requires help in supporting the proposed interventions to accelerate the impact on the community. Furthermore, the institute needs support in building capacity to provide technical assistance to communities, support the population-based strategies of monitoring diet, and reduce sugar and alcohol consumption. The organization also needs help in providing the aid for strengthening the oral health systems to become integral to these communities and do not cause further financial hardships. References Coseo, D. (2020). Why is Oral Health Care Important? | NewMouth. NewMouth. Retrieved 4 May 2021, from https://www.newmouth.com/oral-health/. Mejia, G., Elani, H., Harper, S., Murray Thomson, W., Ju, X., & Kawachi, I. et al. (2018). Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States. BMC Oral Health, 18(1). https://doi.org/10.1186/s12903-018-0630-3 Mo Gov. (2021). Oral Health Intrvention. Retrieved 4 May 2021, from https://health.mo.gov/data/InterventionMICA/OralHealth/CampaignsandPromotions/i ndex.html. NIH. (2020). NIDCR. Nidcr.nih.gov. Retrieved 4 May 2021, from https://www.nidcr.nih.gov/about-us/leadership-staff. Oberoi, S., Sharma, G., & Oberoi, A. (2016). A cross-sectional survey to assess the effect of socioeconomic status on the oral hygiene habits. Journal Of Indian Society Of Periodontology, 20(5), 531. https://doi.org/10.4103/0972-124x.201629 S, S., & M, Z. (2021). Factors Affecting Oral Hygiene and Tooth Brushing in Preschool Children, Shiraz/Iran. NCBI, 4(2). Retrieved 4 May 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608069/. WHO. (2020). Oral health. Who.int. Retrieved 4 May 2021, from https://www.who.int/news -room/fact-sheets/detail/oral-health. WHO. (2021). WHO | Strategies and approaches in oral disease prevention and health promotion. Who.int. Retrieved 4 May 2021, from https://www.who.int/oral_health/strategies/cont/en/. Anthony Yacoub Professor Gideonese PH 195W 27 April 2021 National Institute of Dental and Craniofacial Research The name of my sub-agency is the National Institute of Dental and Craniofacial Research (NIDCR) and the name of my selected study section is The Oral, Dental and Craniofacial Sciences. I chose this sub-agency because it closely ties to my practicum site and lead article because of the mentioning of dentistry and the projects that I work on with internship. The projects I work on with my internship deals with oral hygiene which is what this study section and sub-agency work with. The sub-agency provides leadership for national research to be designed to help understand, treat, and prevent infectious and inherited craniofacial-oral-dental diseases that take away many people’s lives. The Oral, Dental and Craniofacial Sciences study section works a lot with the investigation of teeth and the oral cavity. They deal with the development of oral hard tissue and enamel. Periodontal bone remodeling and pathogenesis of oral and dental diseases are also featured. The National Institute of Dental and Craniofacial Research holds its funding priorities in oral health and overall health. They visioned a plan from 2020-2025 to focus on a future of dental, oral, and craniofacial health and diseases as they are understood in the context of the whole body. In this case, the specified area of focus for both the sub-agency and the study section overlap. The study section mentioned also works on various studies that also relate to the overall health of individuals rather than just focusing strictly on the oral cavity and the health of the teeth. The National Institute of Dental and Craniofacial Research offer grant programs that include: Oral and Comprehensive Health, Oral and Salivary Cancer Biology, Oral Health Disparities and Inequities, and many others that are oral concentrated as well as grants that deal with the overall health of an individual. This agency includes a list of funding opportunities that could easily be found and include application forms for easy access on the same page. The goal of this agency is clear and the intentions are straightforward as it sets an aim to advance the nation’s oral health through research and innovation. OMB Number: 4040-0001 Expiration Date: 12/31/2022 APPLICATION FOR FEDERAL ASSISTANCE 3. DATE RECEIVED BY STATE 1. TYPE OF SUBMISSION 4. a. Federal Identifier SF 424 (R&R) Pre-application ? Application 2. DATE SUBMITTED Changed/Corrected Application State Application Identifier b. Agency Routing Identifier Applicant Identifier c. Previous Grants.gov Tracking ID 5. APPLICANT INFORMATION Organizational DUNS: Legal Name: Department: Division: Street1: Street2: City: County / Parish: Province: State: Country: ZIP / Postal Code: Person to be contacted on matters involving this application Prefix: First Name: Middle Name: Last Name: Suffix: Position/Title: Street1: Street2: City: County / Parish: State: Province: Country: ZIP / Postal Code: Phone Number: Fax Number: Email: 6. EMPLOYER IDENTIFICATION (EIN) or (TIN): 7. TYPE OF APPLICANT: Other (Specify): Small Business Organization Type Women Owned 8. TYPE OF APPLICATION: ? New Renewal If Revision, mark appropriate box(es). Resubmission Continuation Socially and Economically Disadvantaged A. Increase Award Revision Is this application being submitted to other agencies? B. Decrease Award E. Other (specify): Yes No ? What other Agencies? 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: TITLE: 9. NAME OF FEDERAL AGENCY: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 12. PROPOSED PROJECT: Start Date Ending Date C. Increase Duration 13. CONGRESSIONAL DISTRICT OF APPLICANT D. Decrease Duration SF 424 (R&R) Page 2 APPLICATION FOR FEDERAL ASSISTANCE 14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: First Name: Middle Name: Last Name: Suffix: Position/Title: Organization Name: Department: Division: Street1: Street2: County / Parish: City: State: Province: Country: ZIP / Postal Code: Phone Number: Fax Number: Email: 15. ESTIMATED PROJECT FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Total Federal Funds Requested a. YES b. Total Non-Federal Funds ? THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: DATE: c. Total Federal & Non-Federal Funds b. NO d. Estimated Program Income PROGRAM IS NOT COVERED BY E.O. 12372; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious. or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) ? I agree *The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Add Attachment Delete Attachment View Attachment 19. Authorized Representative First Name: Prefix: Middle Name: Suffix: Last Name: Position/Title: Organization: Department: Division: Street1: Street2: City: County / Parish: State: Province: Country: ZIP / Postal Code: Phone Number: Fax Number: Email: Date Signed Signature of Authorized Representative 20. Pre-application Add Attachment Delete Attachment View Attachment 21. Cover Letter Attachment Add Attachment Delete Attachment View Attachment I. Hypothesis and Specific Aims: The objective of this project is to demonstrate new methods regarding studies done previously and to work on patient care quality, which is a common challenge in the sector of health. The aims that the study aims to accomplish are: A. To increase patients’ safety by using initiatives that are relevant. B. To implement innovations in the patient’s health care sector. II. Methodology A. Study Design The type of study design that will be used is the cross-sectional study which will include follow-ups to assess the effects of increasing the safety of patients and innovations in healthcare. Through follow-ups studies, the results will be more successful. B. Sample selection The study will take place in California, United States of America. The individuals to participate in this study are in-patients and outpatients in Cedars-Sinai Medical center of 15 years and above. A total of 72 patients will be involved in this study. C. Data Collection The data will be collected through interviews, observations and questionnaires. The patients will be given templates with questions regarding the type of care they are facing and if they are satisfied with it. Moreover, they would be asked to provide suggestions on how the quality of care they receive can be improved. Observations on how nurses, doctors and other medical staff care for their patients to find out on what sectors need improvements. D. Data Analysis The data collected from the respondents will be analyzed using the qualitative content method of analyzing data. Frequencies in which complaints have been said or written by patients regarding the type of care received will be critically analyzed. Also, suggestions regarding improvement techniques will be key in analyses. Lengthy or large amounts of responses will be grouped in codes and summarized into themes and categories, and get tabulated. III. Ethics A. Protection of human subjects Interests and welfare of the humans that will be involved in this research will be key in order to reduce the chances of offending them or of risk occurrence. Any risks that may occur during the research will be assessed, and the steps that are required to protect the subjects from the risks will be carried out effectively before the beginning of the research. B. Consent and confidentiality The data provided by one respondent will be very confidential for any other respondent or person apart from the researcher to see. The interview will be carried out in turns and privately to avoid disclosing information that may be very confidential to a participant. The questionnaire filled documents will be locked in secure places. C. Data sharing The data obtained from this research will be shared with other researchers. This will be done through a qualitative method whereby codebooks, transcripts and interview guides will be used in order to make it possible for others to verify claims rationales in a certain qualitative study and also to yield new insights. IV. Timeline The study will be conducted for a period of one month which is enough to collect all the necessary information on the possible ways to improve the care provided to patients. The first week will involve preparation for the study and assembling all the required materials, and visiting the study site to plan on how the research will be conducted. The third week will involve information collection and the final week is when data will be compiled and the results analyzed. Grant Proposal First Draft Anthony Yacoub University of California, Irvine Public Health 195W Professor Gideonse 4 May 2021 Organizational Information The National Institute of Dental and Craniofacial Research (NIDCR) has a mission to improve oral, dental, and craniofacial health based on its research, training, and intervention programs. The institute aims to accomplish this mission by supporting clinical research on oral hygiene and conducting and funding research training that enables career development. Furthermore, the research institute coordinates and assists in relevant research and related activities in all sectors of community research and promotes transferring knowledge from the study conducted, including its implications on public health, health professionals, policymakers, and researchers (NIH, 2020). NIDCR launched its 2030 goal in 2017. It envisioned an initiative to imagine a future where most of the population understood dental, oral, and craniofacial health and its context on how these aspects impacted an individual's overall health. Besides, this initiative aims to promote health, treat oral-related diseases, and propose overcoming health disparities. Because of the necessity of this intervention program, NIDCR seeks help to develop and fund the 2020-2025 strategic plan (NIH, 2020). This strategic plan will guide the funding for the institute for the next half-decade. In this case, strategic planning involves establishing priorities, setting straightforward goals, and detailing the actions necessary to achieve set goals (NIH, 2020). The NIDCR plan consists of focusing resources and energy on attaining common set goals with agreed outcomes. NIDCR established five priority sections for the strategic plan, including oral and overall health, precision oral health, regenerative medicine, health disparities, and a diverse workforce (NIH, 2020). The institute also released a Request for Information (RFI) to solicit feedback on these priority sectors to create an initiative to help accomplish the objectives. Statement of Need Oral hygiene begins with having clean teeth, having an awareness of daily habits, and having proper dental care routines. Therefore, oral health care is significant because it lowers the risk of developing diseases such as cavities, periodontal disease, gingivitis, cracked tooth syndrome, bruxism-related conditions, among others (Coseo, 2020). Healthy oral practices allow individuals to smell better, taste, chew, swallow, speak, and smile confidently. Numerous oral conditions affect both children and adults. While some situations may be minor, others can be significantly serious and result in health complications with time. Some of these conditions include (WHO, 2020); · Bruxism- this condition causes excessive teeth grinding, especially when asleep. · Bad breath- also known as halitosis, this condition is characterized by chronic bad breath. · Dry mouth is a condition where salivary glands do not produce enough saliva and are also known as xerostomia. · Toothaches- this condition is characterized by pain near or in a tooth and is typically a consequence of tooth decay or abscess. · Cracked teeth- this condition involves having minor to severe cracks in teeth often caused by bruxism, an injury, among other factors. · Tooth sensitivity- this condition involves a tooth being sensitive to hot, cold, or sweet substances · Temporomandibular Joint Dysfunction- this condition causes significant pain in the jaws. · Mouth Breathing- this condition results in an individual regularly breathing through their mouth in their sleep. · Gum recession- this condition is where gums begin to pull back from the teeth, which exposes the tooth or the root of the tooth. · Burning mouth- this condition is a consistent burning or tingling sensation in the mouth. · Gingival Hyperplasia- this condition is the overgrowth of the gum tissue around the teeth. Furthermore, there are various oral diseases. Oral diseases are considerably more severe than oral conditions, where when left untreated, they can cause tooth loss or permanent damage to the surrounding areas. Some of the oral diseases include (WHO, 2020); · Gingivitis- this disease is an irreversible minor gum disease. · Periodontal disease- a severe gum disease that often results in permanent loss of bone. · Cavities- this disease is tooth decay, whether minor or significant. · Oral thrush- this disease is a yeast infection of the mouth. · Dental Abscess- a pocket of pus in a tooth. · Oral cancer- a form of cancer affecting the mouth or throat. Excessive alcohol consumption, tobacco use, and unhealthy eating habits can cause oral health to deteriorate over time. While general health conditions can typically worsen existing oral health situations, poor oral hygiene has been a risk factor for several issues. One of the risk factors of poor oral health is heart disease. Diseases such as gingivitis, when left untreated, become periodontal disease. This gum disease links to increased rates of cardiovascular disease because bad oral hygiene increases the risk of developing a bacterial infection that can reach the bloodstream and spread to the heart valves (Coseo, 2020). Furthermore, with untreated oral diseases, individuals risk developing chronic diseases such as diabetes or increasing the risk of getting a stroke with age. Poor dental hygiene also results in a weakened immune system, which increases the probability of developing infections, illnesses, and diseases. Therefore, because of the adverse effects of neglected oral health, this proposal by the NIDCR is necessary to create awareness on matters of oral hygiene and its impacts on individuals, families, and the community. Project Description According to WHO (2021), the threat of non-communicable diseases and the need to provide urgent and efficient public health responses led to the formulation of a global strategy to control and prevent these diseases. Similarly, the NIDCR aims to create designs for intervention on oral health and oral diseases. The institute will prioritize diseases linked by common, preventable, and lifestyle-related risk factors such as tobacco use or unhealthy diet. There is a relatively high risk of oral disease relating to socio-cultural determinants, including low income, low education levels, beliefs, and culture supporting oral health. According to Mejia et al. (2018), socioeconomic status has long been an area of interest in its effect on oral health. A majority of the evidence indicates that socioeconomic inequalities are typically associated with oral health status, both subjectively and objectively (Mejia et al., 2018). Therefore, it is necessary to monitor social inequalities and disparities in oral health to provide information on the differences populations face, their oral hygiene needs, oral health priorities, and preventive practices. Besides, previous studies demonstrate that socioeconomic positioning is negatively associated with oral health and dental diseases. The higher the income a family has, the better equipped they are to have information and experience fewer oral hygiene and dental conditions. In addition, education and income become significantly relevant indicators used in the epidemiology for socioeconomic status measurement, according to Mejia et al. (2018). Oral health counts as a constituent of general health, relying on subjective perceptions, while disease measurement utilizes objective indicators. Also, communities or regions with irregular exposure to fluorides are at an increased risk of dental cavities. At the same time, the settings with poor access to safe drinking water or sanitary facilities pose environmental risk factors to both oral and general health (S & M, 2021). Also, controlling oral diseases significantly depends on the accessibility and availability of oral health systems. However, reducing risks to oral disease is only plausible if there is an orientation of services towards prevention. Further to the socio-environmental aspects, this model emphasizes the role of intermediate and modifiable risk behaviors such as oral health practices, diet, and alcohol and substance use (S & M, 2021). These behaviors may affect not only the overall oral hygiene of individuals but also their quality of life. Clinical and public health research indicates that individual, professional, and community preventive measures are efficient in preventing oral diseases (WHO, 2021). However, the optimal intervention measures for oral diseases are not available universally, nor is it affordable because of the costs associated with dental health and limited resources. Coupled with the lack of emphasis on primary prevention measures for oral diseases, there is a significant challenge for many communities, especially for communities in low-income settlements that cannot access such services. A considerable portion of the evidence relates to preventing dental cavities and controlling periodontal diseases (WHO, 2021). Prevention of gingivitis is possible using proper oral hygiene practices, including regular brushing and flossing. These procedures are also valuable for controlling periodontal lesions, according to WHO (2021). Furthermore, an initiative such as community water fluoridation is an effective method of preventing dental cavities for adults and children. Water fluoridation works to benefit the community in its entirety by supplying water regardless of socioeconomic status. Milk and salt fluoridation schemes also have similar effects on dental health when used as preventive programs for communities. Therefore, both individual and professional measures such as fluoride mouth rinses, gels, kinds of toothpaste, and use of dental sealants are additional methods of prevention of dental cavities (Oberoi et al., 2016). In several communities, poor income communities, the introduction of fluoridated toothpaste has been a valuable strategy, which has ensured that individuals remain appropriately exposed to fluorides. Therefore, individuals can take personal actions for themselves and their families to prevent dental diseases and maintain hygiene. Combined with proper nutrition and diet, the primary prevention of most oral, dental, and craniofacial diseases is achievable. Lifestyle habits such as tobacco use, poor dietary choices, and excessive alcohol consumption affect dental hygiene and have significant effects on general health. Such behaviors are also associated with an increased risk of congenital craniofacial disabilities, periodontal diseases, dental cavities, oral candidiasis, pharyngeal cancers, among others (Oberoi et al., 2016). Also, opportunities exist to further expand the prevention of oral disease and promote health information and practices to the public using community programs and healthcare settings (WHO, 2021). As oral health care providers, the institute plays a significant role in promoting healthy lifestyles by incorporating tobacco cessation programs and utilizing nutrition counseling in daily practices (WHO, 2021). However, there exist some essential oral health disparities across various regions. These disparities typically relate to socioeconomic status, ethnicity, and race, age, gender, or in some cases, the status of general health, according to WHO (2021). While specific dental diseases are preventable, there is evidence that not all community members are adequately informed or are in a position to benefit from measures for appropriate health promotion. In this instance, the underserved communities and populations are evident in both developed and developing countries. However, in most countries, oral healthcare lacks full integration into the community and national programs, according to WHO (2021). The strategies for intervention for oral health care involve utilizing intervention tools to increase awareness about oral diseases and conditions and promote oral health habits among community members (Mo Gov, 2021). NIDCR aims to use campaigns and promotions on media outlets such as television and radio, and other modes of communication, including issuing brochures with intervention messages. Furthermore, with public figures or celebrity figures, the institute can endorse oral hygiene, diseases, conditions, and treatment options. Therefore, the institute must utilize consistent messages across these various communication channels to ensure the public remains aware. According to Mo Gov (2021), these oral health campaigns and promotions can increase awareness of the health risks of oral diseases and conditions and highlight their association with other health conditions. Furthermore, these campaigns aim to promote behavioral changes, reduce the risk of oral infections and diseases, and improve the knowledge and skills related to the benefits or challenges of proper habits for dental care. These campaigns also aim to change community norms by encouraging protective mouth gear for sports, reducing sugar and alcohol consumption, and ceasing tobacco use. The significant challenges of the future of this intervention program will exist in translating knowledge and experiences about the prevention of oral diseases into actionable programs. The social, economic, and cultural factors and the shifting population demographics rely significantly on delivering oral health services and how individuals care for themselves and their families. Therefore, reducing the disparities requires a wide range of approaches that target the high-risk populations for particular oral diseases and improve their access to proper care. Meanwhile, the most significant challenge for communities in low-income areas is offering oral health care within the context of primary health programs. These programs aim to meet the basic health needs of these populations, improve active outreach to the community, facilitate primary care, and pursue effective referral of patients, according to WHO (2021). Therefore, for these interventions to be available for communities in the United States, the existing partnerships require strengthening, especially with non-profit organizations. This participation of numerous organizations includes collaborating, encouraging community participation, creating policies towards oral health care reforms, and developing strategies for oral disease control in communities. Conclusion To sum up, oral health is a significant issue in the community that requires addressing. The NIDCR aims to facilitate intervention programs aimed at reducing oral health conditions and diseases in communities. These interventions need reforms of oral health systems to change the focus from invasive treatment options and towards prevention and use of minor treatments. The NIDCR identified various strategies for improving oral health, focusing on low-income and marginalized communities who have challenges accessing oral care. These strategies include population-wide prevention measures that are cost-effective and having patient-centered primary care. The NIDCR requires help in supporting the proposed interventions to accelerate the impact on the community. Furthermore, the institute needs support in building capacity to provide technical assistance to communities, support the population-based strategies of monitoring diet, and reduce sugar and alcohol consumption. The organization also needs help in providing the aid for strengthening the oral health systems to become integral to these communities and do not cause further financial hardships. References Coseo, D. (2020). Why is Oral Health Care Important? | NewMouth. NewMouth. Retrieved 4 May 2021, from https://www.newmouth.com/oral-health/. Mejia, G., Elani, H., Harper, S., Murray Thomson, W., Ju, X., & Kawachi, I. et al. (2018). Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States. BMC Oral Health, 18(1). https://doi.org/10.1186/s12903-018-0630-3 Mo Gov. (2021). Oral Health Intrvention. Retrieved 4 May 2021, from https://health.mo.gov/data/InterventionMICA/OralHealth/CampaignsandPromotions/i ndex.html. NIH. (2020). NIDCR. Nidcr.nih.gov. Retrieved 4 May 2021, from https://www.nidcr.nih.gov/about-us/leadership-staff. Oberoi, S., Sharma, G., & Oberoi, A. (2016). A cross-sectional survey to assess the effect of socioeconomic status on the oral hygiene habits. Journal Of Indian Society Of Periodontology, 20(5), 531. https://doi.org/10.4103/0972-124x.201629 S, S., & M, Z. (2021). Factors Affecting Oral Hygiene and Tooth Brushing in Preschool Children, Shiraz/Iran. NCBI, 4(2). Retrieved 4 May 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608069/. WHO. (2020). Oral health. Who.int. Retrieved 4 May 2021, from https://www.who.int/news -room/fact-sheets/detail/oral-health. WHO. (2021). WHO | Strategies and approaches in oral disease prevention and health promotion. Who.int. Retrieved 4 May 2021, from https://www.who.int/oral_health/strategies/cont/en/. Dear Christine Nguyen, I have reviewed the comments you made on the second draft of my grant proposal and have addressed your comments in my final draft. I have fixed minor details and grammar errors all throughout the entire proposal to include missing information and improve the overall flow. I hope you enjoy the final draft of my grant proposal. In the cover letter I have included the dollar amount requested for the funding in this project and have also shortened one of the sentences to remove unnecessary wording. For the organizational information, I have explained how the research is relevant to the site which was not explained clearly in my previous draft. For the project summary, the main issue was sentence length. To correct this, I broke up the lengthier sentence into two smaller sentences. The public health significance section was merged with my project summary, now it is given its own section with a heading. In this section I have discerned whether each goal is long or short term. In the timeline, I have included the names of the months to be more specific and to provide clarity. I have also clarified the future research directions because it was incorrectly done in my last draft. Other minor errors were fixed that included eliminating all first-person perspective sentences and grammar errors. Sincerely, Todrick Tamandua 1 Social Epidemiology and Research in Community Health Lab 653 E. Peltason Dr. Irvine, CA 92617 16 February 2021 NIH Center for Scientific Research 6701 Rockledge Drive Room 1040-MSC 7710 Bethesda, MD 20817 To Whom it May Concern: I am pleased to present this grant proposal titled “Vaccination Beliefs and Barriers in Lowincome, Urban Populations” for consideration under the NIH Research Grant Program (R01) with PA-20-185 which was discussed with Jennifer Alvidrez. Please assign this application to the following: Institutes/Centers National Institute on Minority Health and Health Disparities (NIMHD) Scientific Review Groups Community Influences on Health Behavior (CIHB) This project corresponds with the missions of NIMHD which is to enhance the healthcare among minority communities to reduce health disparities. This correlates with the goals of this study because the main focal point is on low-income, urban communities and understanding how their vaccination beliefs affect these groups in pandemic situations. These impoverished areas are home to minority groups and their vaccination beliefs assist in understanding any barriers to healthcare they have. We are respectfully requesting $427,099.94. The NIH study section being requested is the CIHB. This study section focuses on how community factors influence health behaviors and risks. This relates closely to my study because it focuses on the community level and how specific factors of that community impact the general health of the populations and my chosen study focuses on vaccination beliefs in the low-income, urban populations of Los Angeles County. Sincerely, Emily Drum Site Supervisor OMB Number: 4040-0001 Expiration Date: 12/31/2022 APPLICATION FOR FEDERAL ASSISTANCE 3. DATE RECEIVED BY STATE 1. TYPE OF SUBMISSION 4. a. Federal Identifier SF 424 (R&R) Pre-application Application 2. DATE SUBMITTED Changed/Corrected Application State Application Identifier b. Agency Routing Identifier Applicant Identifier c. Previous Grants.gov Tracking ID 2-23-2021 5. APPLICANT INFORMATION Organizational DUNS: Social Epidemiology and Research in Community Health Legal Name: Department: Division: 653 E. Peltason Drive Street1: Street2: State: Irvine California Country: USA: United States of America City: County / Parish: Province: ZIP / Postal Code: 92617 Person to be contacted on matters involving this application Prefix: First Name: Todrick Middle Name: Tamandua Last Name: Suffix: Position/Title: 653 E. Peltason Drive Street1: Street2: City: Irvine State: California Province: Country: USA: United States of America ZIP / Postal Code: Phone Number: Email: County / Parish: (949)824-5011 92617 Fax Number: bonavene@uci.edu 6. EMPLOYER IDENTIFICATION (EIN) or (TIN): 7. TYPE OF APPLICANT: H. Public/State Controlled Institution of Higher Education Other (Specify): Small Business Organization Type Women Owned 8. TYPE OF APPLICATION: New Renewal If Revision, mark appropriate box(es). Resubmission Continuation Socially and Economically Disadvantaged A. Increase Award Revision Is this application being submitted to other agencies? B. Decrease Award E. Other (specify): Yes No What other Agencies? 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: TITLE: 9. NAME OF FEDERAL AGENCY: National Institute on Minority Health and Health Disparities 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: Vaccination Beliefs and Barriers in Low-Income, Urban Populations 12. PROPOSED PROJECT: Start Date Ending Date 4-01-2021 4-01-2022 C. Increase Duration 13. CONGRESSIONAL DISTRICT OF APPLICANT CA-45 D. Decrease Duration 2 SF 424 (R&R) Page 2 APPLICATION FOR FEDERAL ASSISTANCE 14. PROJECT DIRECTOR/PRINCIPAL INVESTIGATOR CONTACT INFORMATION Prefix: First Name: Emily Middle Name: Drum Last Name: Suffix: Research Manager Position/Title: Organization Name: Social Epidemiology and Research in Community Health Lab Department: Division: 653 E. Peltason Drive Street1: Street2: City: Irvine State: California Country: USA: United States of America Phone Number: County / Parish: Province: (949)824-5011 ZIP / Postal Code: 92617 92617 Fax Number: edrum@hs.uci.edu Email: 15. ESTIMATED PROJECT FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Total Federal Funds Requested $427,099.94 b. Total Non-Federal Funds $0 c. Total Federal & Non-Federal Funds $427,099.94 d. Estimated Program Income $0 a. YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: DATE: b. NO 2-23-2021 PROGRAM IS NOT COVERED BY E.O. 12372; OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 17. By signing this application, I certify (1) to the statements contained in the list of certifications* and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances * and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious. or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) I agree *The list of certifications and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency specific instructions. 18. SFLLL (Disclosure of Lobbying Activities) or other Explanatory Documentation Add Attachment Delete Attachment View Attachment 19. Authorized Representative First Name: Prefix: Last Name: Middle Name: Todrick Suffix: Tamandua Position/Title: Director of Extramural Funding Organization: Social Epidemiology and Research in Community Health Lab Department: Street1: Division: 653 E. Peltason Dr. Street2: City: State: Country: California Province: ZIP / Postal Code: USA: United States of America Phone Number: Email: County / Parish: Irvine (949)824-5011 92617 Fax Number: bonavene@uci.edu Date Signed Signature of Authorized Representative 2-16-2021 20. Pre-application Add Attachment Delete Attachment View Attachment 21. Cover Letter Attachment Add Attachment Delete Attachment View Attachment 3 4 Organization Information The Social Epidemiology and Research in Community Health (SEARCH) lab at the University of California, Irvine assists with activities that aid research conducted by Dean Bernadette Boden-Albala. The mission of SEARCH lab and the research done by Dean Bernadette Boden-Albala is to utilize behavioral and demographic data to analyze disease risk factors on a global and domestic level. A large portion of her research consists of stroke prevention studies as well as how to combat health disparities among minority groups. Dean Bernadette Boden-Albala is the director and founding dean of the program in public health at UCI; she is an expert in the social epidemiology of cardiovascular disease and stroke. SEARCH Lab centers on the biological and social mechanisms that frame the health of different communities and populations globally and involves research assistants as well as undergraduate interns. Seeing that this lab focuses on the social epidemiology aspect of public health, the components of an individual’s surroundings that include their cultural, economic, social, and psychological environment are examined based on their interactions and how they affect well-being, disease, and health. The purpose of social epidemiology is to define and intervene on the social determinants of disease and to analyze how the role of sex, race, ethnicity, social network, stress and so forth impacts health on all levels. Within this lab, literature reviews are conducted, research material and studies are developed, and other procedural support for these research activities are carried out with its focal point on COVID-19, stroke, chronic disease, and risk factors among populations that are overlooked but are at high risk for health disparities and disease. This research is relevant to the site because all of the literature reviews and research studies being conducted fall under the category of COVID-19, stroke, and minority groups. 5 Project Summary During this cross-sectional study, the overall objective is to examine and analyze the vaccination beliefs among individuals in the urban, low-income population of Los Angeles County to create an understanding of the impact these beliefs have during a pandemic situation and to apply the results of this study to other high-risk communities. Moreover, this crosssectional study will also investigate the impact that transportation to vaccine dissemination sites and affordability of vaccination has on these attitudes and beliefs. The results of this study will have external validity that can be applied to similar communities. This will allow for a creation of a profile that can be applied to these communities and also be utilized by public health officials to enhance outreach to these vulnerable individuals as well as increase pandemic preparedness. All of which will be achieved by conducting a cross-sectional survey of 1,500 individuals in Los Angeles County. These individuals will be selected from five free public health clinics that are located in the impoverished areas of the county. On selected days, researchers will be recruiting and enrolling participants in the waiting room of these clinics using a systematic serial sampling process. Prior to completing the survey, respondents will give their informed consent and their responses will remain confidential with Human Subjects protection. This 36-question survey will have a combination of short answer and multiple-choice responses and descriptive analyses will be used to generate the frequency distribution using the SAS system. Under a data-sharing agreement the results of this study will be made available to participants and other researchers. This study will take a total of 12 months and will require $427,099.94 of federal funding. 6 Public Health Significance For this study, the impact that affordability of vaccines and transportation to vaccine dissemination sites has on the attitude and beliefs towards seasonal influenza vaccination will be observed among the low-income, urban population in Los Angeles County. The public health significance is that the results from this study will then be used to create a profile for other highrisk populations to contribute to increasing pandemic preparedness and decreasing mortality and infection rate among vulnerable populations. This study will also create a better understanding of the barriers to vaccination these populations face and will give public health officials a better idea on how to eliminate these barriers and increase vaccination accessibility in the long term. It will also provide an opportunity to correct any myths or misconceptions members of these communities have on vaccination in the short term as well as improving vaccination knowledge overall in the long term. 7 Statement of Need/Objective Rapid dissemination of a vaccine is key to reducing the mortality rate during a pandemic, yet uptake of these vaccinations face multiple challenges and vulnerable populations are immensely affected (Redelings et al., 2012). The purpose of this cross-sectional survey is to analyze the beliefs and attitudes about the seasonal influenza vaccine in low-income populations in the urban areas of Los Angeles County. Disparities among racial/ethnic groups propose that these underserved groups are disproportionately impacted by influenza strains during a pandemic (Redelings et al., 2012). Understanding the attitude, knowledge, and beliefs of vaccinations in these populations can aid influenza pandemic efforts given by health departments. Vaccines have demonstrated proven effectiveness and prevent approximately 2 to 3 million deaths a year (Gualano et al., 2019). This cross-sectional study will not only evaluate the attitude, knowledge, and beliefs about the seasonal influenza vaccination in the urban, low-income areas of Los Angeles County, but it will also take into consideration the impact that affordability of vaccination and transportation to vaccination dissemination sites has on these beliefs which is a current gap in knowledge. A qualitative study in Appalachian, Kentucky indicated that transportation was a major factor among the uptake of the HPV vaccine for women; many described transportation as problematic and results revealed that these transportation issues served as a barrier to receiving the HPV vaccine (Mills et al., 2013). It is essential to consider transportation because if vaccinations are not even accessible to an individual or group of people it forms an obstacle and has the ability to alter perception of vaccination. In a study conducted on the role that affordability had on the uptake of the HPV vaccination, the results revealed that insurance and cost barriers need to be considered; higher income individuals and those with HMOs were more 8 likely to of finished or initiated the HPV vaccination series (Pourat & Jones, 2012). Both transportation and affordability are major deciding factors for receiving a vaccination and need to be considered in order to effectively evaluate vaccination beliefs and understand vaccination uptake especially among overlooked populations. Compared to previous studies, this study is new and innovative because it will utilize the affordability and transportation component of receiving the seasonal influenza vaccination among underserved communities and will apply the external validity of the results to other urban, low-income populations with an overall objective to increase pandemic preparedness. Studies have been conducted on observing vaccination beliefs among high-risk groups but not on the root of these beliefs and what can be done since vaccination decisions have ramifications on the individual and public health as a whole. At this given time, there are many groups domestically and globally who refuse to receive recommended vaccinations and this opposition remains widespread despite the demonstrated efficacy of these vaccinations (Gualano et al., 2019). Pandemic situations can be unpredictable, and the impact of this study would identify any misconceptions, concerns, and barriers these high-risk populations have in order to give public health officials an idea on how to curve the seasonal influenza pandemic and other pandemic situations overall. 9 Project Description/Narrative Hypothesis and Specific Aims The overall objective of this project is to observe vaccination beliefs, attitudes, and knowledge about the seasonal influenza vaccine in the urban, low-income population of Los Angeles County. The results from this study will then be applied to other urban, low-income populations to enhance pandemic preparedness and decrease infection and mortality rate within these high-risk populations. Aim 1 is to examine the impact transportation to clinic sites and...
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