CDC-RFA-DP-25-0024_FINAL.pdf

Office of the Director

Notice of Funding Opportunity

Application due January 15, 2025

Advancing Public Health Actions to Prevent and Control Chronic Disease in the U.S. Territories and Freely Associated States Opportunity number: CDC-RFA-DP-25-0024

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 8

Program description 11

Step 2: Get Ready to Apply 51

Get registered 52

Step 3: Prepare Your Application 54

Application contents and format 55

Step 4: Learn About Review and Award 63

Application review 64

Award notices 73

Step 5: Submit Your Application 74

Application submission and deadlines 75

Application checklist 77

Step 6: Learn What Happens After Award 79

Post-award requirements and administration 80

Contacts and Support 85

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date Applications are due by 11:59 p.m. Eastern Time on January 15, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 8

Program description 11

Basic information Centers for Disease Control and Prevention (CDC)

National Center for Chronic Disease Prevention and Health Promotion

(NCCDPHP)

Office of the Director

Enhancing data-driven and cultural approaches for preventing, managing, and controlling chronic diseases in the U.S. territories and freely associated states.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

Advancing Public Health Actions to Prevent and Control Chronic Disease in the U.S. Territories and Freely Associated States

Opportunity number:

CDC-RFA-DP-25-0024

Federal assistance listing: 93.377

Key dates

Application deadline:

January 15, 2025

Informational call:

December 3, 2024

Expected award date:

February 27, 2025

Expected start date:

March 31, 2025

Summary Six out of ten adults living in the United States have at least one chronic disease. The cost of managing individuals with chronic conditions is a significant portion of the nation’s healthcare expenses. The United States has made progress in chronic disease prevention and control over recent decades. However, similar advancements have not been made in the U.S.

territories and freely associated states.

The U.S. territories and freely associated states include:

• American Samoa

• The Commonwealth of the Northern Mariana Islands (CNMI)

• The Federated States of Micronesia (FSM)

• Guam

• Puerto Rico

• The Republic of the Marshall Islands (RMI)

• The Republic of Palau (Palau)

• The U.S. Virgin Islands (USVI)

The unique challenges these islands face make addressing chronic disease particularly complex. These challenges include:

• High disease burden.

• Dispersed populations.

• Limited infrastructure.

• Diverse cultures and languages.

Step 1: Review the Opportunity 5

• Vulnerability to natural disasters.

• Strained healthcare systems.

• High healthcare costs.

This cooperative agreement will support integrated, evidence-based strategies and activities to prevent and manage chronic disease in the U.S.

territories and freely associated states. This notice of funding opportunity (NOFO) aims to reduce disability and death rates associated with chronic diseases by decreasing the prevalence of modifiable risk factors that contribute to chronic diseases in these islands. Focus areas include:

• Preventing and reducing tobacco use and secondhand smoke exposure.

• Preventing and managing diabetes.

• Improving oral health disparities.

There are two components to this NOFO. The first is a required Core Component, which uses evidence-based strategies to promote health and reduce chronic disease. The second is an optional, competitive Oral Health Component, which addresses oral disease with evidence-based interventions and practices.

Note on key terms

In this NOFO, we use the terms “chronic disease” and “non-communicable disease (NCD)” interchangeably to refer to long-term health conditions that persist over time.

Funding details Type: Cooperative agreement

Expected total program funding over the performance period: $17,450,000

Expected total program funding per budget period: $3,490,000

Expected awards: 8

Funding floor per applicant per budget period: $230,000

Expected average award amount per budget period: $475,000

Average award amount per budget period for the Core Component:

$450,000

Average award amount per budget period for the Oral Health Component:

$200,000

Step 1: Review the Opportunity 6

We plan to award projects for five 12-month budget periods for a five-year period of performance.

The number of awards is subject to available funds and program priorities.

Funding strategy We will only award funding to one recipient per U.S. territory or freely associated state. If we receive multiple applications from the same U.S.

territory or freely associated state, only the highest scoring application will be funded. We will award for each component as follows:

• For the Core Component, we intend to fund up to eight recipients.

• For the Oral Health Component, we intend to fund up to one recipient.

The Oral Health Component recipient must also be awarded for the Core Component.

The number of awards is subject to availability of funds and program priorities.

Step 1: Review the Opportunity 7

Eligibility Who can apply Eligible applicants – open competition Only these types of organizations may apply:

• State governments.

• County governments.

• City or township governments.

• Special district governments.

• Independent school districts.

• Public and state-controlled institutions of higher education.

• Native American tribal governments (federally recognized).

• Public housing authorities and Indian housing authorities.

• Native American tribal organizations, other than federally recognized tribal governments.

• Nonprofits having a 501(c)(3) status, other than institutions of higher education.

• Nonprofits without 501(c)(3) status, other than institutions of higher education.

• Private institutions of higher education.

• For-profit organizations other than small businesses.

• Small businesses.

• Territorial governments or their bona fide agents in the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Non-domestic (non-U.S.) components of U.S. organizations are not eligible to apply. Non-domestic entities (foreign institutions) are not eligible to apply.

Step 1: Review the Opportunity 8

Other required qualifying factors The following additional eligibility requirements apply. If you do not comply with these requirements, we will deem your application non-responsive, and it will not undergo further review.

Ability to access and submit data If you are not a Department or Ministry of Health in the jurisdiction you are applying for, you must attach a memorandum of agreement (MOA) or memorandum of understanding (MOU) with the Department or Ministry of Health in that jurisdiction. We require specific surveillance and health system data from recipients to make sure you are meeting performance measures.

Therefore, you must demonstrate that you will be able to access that data and submit it to us.

The MOU or MOA should specify that the Department or Ministry of Health will do the following:

• Provide you with access to surveillance and health system data.

• Grant you the authority to submit the data to CDC.

• Collaborate with you to make sure complete data are submitted to CDC.

You must provide the MOU or MOA in an attachment labeled “MOU_DataAccess” when you submit your application via Grants.gov.

Location You must provide proof of your location in one of the U.S. territories or freely associated states listed here:

• American Samoa

• The Commonwealth of the Northern Mariana Islands (CNMI)

• The Federated States of Micronesia (FSM)

• Guam

• Puerto Rico

• The Republic of the Marshall Islands (RMI)

• The Republic of Palau (Palau)

• The U.S. Virgin Islands (USVI)

You must be able to implement this program in the U.S. territory or freely associated state in which you operate and are located.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 http://www.grants.gov/

Evidence of location may include documentation showing that you are a territorial government or a bona fide agent in the U.S. territory or freely associated state. A bona fide agent is an agency or organization recognized by the state as eligible to submit an application under state eligibility in place of a state application.

If you are applying as a territorial government or bona fide agent of a jurisdiction or local government, you must attach evidence of location documentation from the state or local government. This documentation must be provided as an attachment labeled “Evidence of Location” when you submit your application via Grants.gov.

Cost sharing and matching funds This program has no cost-sharing requirement or matching funds requirement. If you choose to include cost-sharing funds as a contribution to the award, we won’t consider it during review of your application.

Although cost-sharing or matching funds are not required, we strongly encourage you to leverage other resources and related ongoing efforts to promote sustainability.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 10

Program description Background Overview

The U.S. territories and freely associated states include:

• American Samoa

• The Commonwealth of the Northern Mariana Islands (CNMI)

• The Federated States of Micronesia (FSM)

• Guam

• Puerto Rico

• The Republic of the Marshall Islands (RMI)

• The Republic of Palau (Palau)

• The U.S. Virgin Islands (USVI)

For more than 10 years, CDC has supported a variety of strategies and activities aimed at improving island health by preventing chronic diseases and their risk factors, improving chronic disease management, and promoting healthy behaviors.

In recent decades, chronic disease prevention and control have improved in the U.S. However, progress is slower in the U.S. territories and freely associated states. These islands often have higher rates of chronic diseases and associated risk factors. In order to reduce chronic disease rates in the Islands among all population groups, raising public and decision maker awareness of the population health impact of chronic diseases and their associated risk factors as well as the evidence-based policies and interventions that prevent and reduce them, must be continually addressed.

Addressing chronic disease in these islands is challenging for many reasons, including:

• High disease burden.

• Dispersed populations.

• Limited infrastructure.

• Limited availability of surveillance data.

• Diverse cultures and languages.

Step 1: Review the Opportunity 11

• Vulnerability to natural disasters.

• Strained healthcare systems.

• High healthcare costs.

Promoting health equity is essential for effective chronic disease prevention.

By understanding the unique perspectives and context of island communities and tailoring strategies to match, programs can reduce health disparities and improve overall well-being in the U.S. territories and freely associated states.

This NOFO will focus on strategies that address health disparities and social determinants of health, as reflected in the NCCDPHP Approach to Social Determinants of Health.

This NOFO builds on the lessons learned from two previous cooperative agreements, CDC-RFA-DP14-1406 and CDC-RFA-DP19-1901. The strategies and activities supported by this NOFO have been tailored to align more closely with the specific needs, capabilities, capacity, and interests of the islands. Our goal is to address the root causes of chronic disease and prioritize impactful approaches.

Related work The following CDC programs conduct work related to the programs funded through this NOFO.

• Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S. Affiliated Pacific Islands, U.S. Virgin Islands, and Puerto Rico

(CDC-RFA-DP19-1901)

• National and State Tobacco Control Program

• Racial and Ethnic Approaches to Community Health (REACH)

• State Actions to Improve Oral Health Outcomes - Funded Oral Health Programs

• State Physical Activity and Nutrition (SPAN) Program

• The National Cardiovascular Health Program

Other CDC resources These resources may be helpful for planning related programs:

• Disability and Health Promotion

• Heart Disease and Stroke Best Practices Clearinghouse

• National Diabetes Prevention Program Customer Service Center

• CDC Diabetes Self-Management Education and Support Toolkit

• The Community Guide

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://www.cdc.gov/health-equity-chronic-disease/social-determinants-of-health-and-chronic-disease/index.html https://www.cdc.gov/health-equity-chronic-disease/social-determinants-of-health-and-chronic-disease/index.html https://www.grants.gov/search-results-detail/289144 https://www.grants.gov/grantsws/rest/opportunity/att/download/279719 https://www.grants.gov/grantsws/rest/opportunity/att/download/279719 https://www.grants.gov/grantsws/rest/opportunity/att/download/279719 https://www.grants.gov/grantsws/rest/opportunity/att/download/279719 https://www.cdc.gov/tobacco/php/tobacco-control-programs/?CDC_AAref_Val=https://www.cdc.gov/tobacco/stateandcommunity/tobacco-control/ https://www.cdc.gov/reach/php/reach-2023-2028/?CDC_AAref_Val=https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/reach-2023-2028.html https://wcms-wp.cdc.gov/oral-health/programs/index.html https://wcms-wp.cdc.gov/oral-health/programs/index.html https://www.cdc.gov/span/php/about/index.html?CDC_AAref_Val=https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span/span-2023.html https://www.cdc.gov/cardiovascular-resources/?CDC_AAref_Val=https://www.cdc.gov/dhdsp/programs/spha/index.htm https://www.cdc.gov/ncbddd/disabilityandhealth/partners-and-programs.html https://hdsbpc.cdc.gov/s/ https://nationaldppcsc.cdc.gov/s/ https://www.cdc.gov/diabetes-toolkit/php/index.html https://www.thecommunityguide.org/

• The Public Health Professionals Gateway

• Evidence-Based Tobacco Prevention and Control Guides

• Surgeon General’s Reports on Smoking and Tobacco Use (cdc.gov)

• Oral Health Information and Resources

Purpose The purpose of this NOFO is to improve the health of the U.S. territories and freely associated states by decreasing the prevalence of modifiable risk factors that cause or contribute to chronic diseases. Our goal is to reduce the rates of disability and death associated with the chronic diseases affecting the islands’ populations.

This NOFO includes two components:

• A mandatory Core Component to promote health and reduce chronic diseases within each of the eight U.S. territories and freely associated states.

• An optional, competitive Oral Health Component to address oral health in one of the U.S. territories or freely associated states.

Core Component approach Overview of the Core Component The Core Component is mandatory for all applicants.

The Core Component outlines a set of evidence-based strategies and activities to promote health and reduce chronic disease across the U.S.

territories and freely associated states. The objectives of the Core Component are to:

• Prevent and reduce tobacco use and secondhand smoke exposure.

• Prevent and manage diabetes and diabetes-related complications.

The following logic model includes the strategies and activities under this NOFO. It also includes the program’s expected outcomes. The asterisked outcomes are those we expect you to achieve during the five-year period of performance.

Outcomes are the results that you intend to achieve and usually show the intended direction of change, such as increase or decrease.

Not all outcomes apply to all strategies. The table shows how they apply.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.cdc.gov/publichealthgateway/index.html https://www.cdc.gov/tobacco/php/state-and-community-work/guides-for-states.html?CDC_AAref_Val=https://www.cdc.gov/tobacco/stateandcommunity/guides/index.htm https://www.cdc.gov/tobacco/sgr/index.htm https://www.cdc.gov/oral-health/index.html

Core Component logic model The logic model shows the strategies and activities of the program along with the outcomes we expect over time. The required outcomes are topic specific but may not be limited to one or the other. We will require you to report on the asterisked (*) outcomes as follows.

Table: Core Component strategies and outcomes

Strategies Short-term outcomes (1-2 years)

Intermediate outcomes (2-5 years)

Long-term outcomes (5 years or more)

1. Systematically collect, share, and use non-communicable disease (NCD) population-based and/or clinical data to drive local public health action and evaluate impact.

• Improved completeness and quality of NCD surveillance data.

• Increased capacity to collect, analyze, and disseminate NCD data and data related to tobacco use, secondhand smoke/aerosol exposure, and tobacco-related disparities.

• Increased availability and use of population-based and clinical data on NCDs and risk factors, including those related to tobacco use (for example, educational materials and evidence-based interventions).

• Decreased tobacco use among adults and adolescents.*

• Increase implementation of evidence-based interventions to reduce morbidity, mortality, and disparities due to NCDs and risk factors, including those related to tobacco.*

2. Implement policy, system, and environmental (PSE) change strategies to improve awareness and prevention of chronic disease and associated modifiable risk factors.

• Increased public and decision-maker awareness and knowledge of the risks of chronic disease, including the dangers of tobacco use and the effectiveness of tobacco control interventions and social norm change.*

• Increased awareness about the benefits of smokefree environments and

• Decreased exposure to tobacco marketing.*

• Increased implementation and compliance with tobacco control policies, including comprehensive smokefree policies.*

• Reduced access to tobacco products and reduced social norms accepting of tobacco use.*

• Decreased initiation of tobacco use among youth and young adults.

• Decreased exposure to secondhand smoke/aerosol.

Step 1: Review the Opportunity 14

Strategies Short-term outcomes (1-2 years)

Intermediate outcomes (2-5 years)

Long-term outcomes (5 years or more) increased support for them.*

3. Implement culturally appropriate health communication to prevent and/or control risk factors that lead to chronic disease.

• Increased culturally appropriate health communication interventions and messages to reach both the general population and populations experiencing tobacco-related disparities.*

• Increased reach of prediabetes awareness messages both in the general population and among healthcare professionals.*

• Increased overall quit attempts and increased quit attempts using evidence-based services to help people quit using tobacco.

• Decreased susceptibility to experimentation with tobacco products, including e-cigarettes and other emerging tobacco products.

4. Promote health systems changes to improve screening, treatment, care, and support for people with and at risk for chronic disease.

• Increased health systems that routinely screen for tobacco use, advise tobacco users to quit, and promote and support evidence-based services to help people quit using tobacco.*

• Increased engagement of clinical and public health team members in the

• Increased use of evidence-based services to help people quit using tobacco.

• Increased overall quit attempts and increased quit attempts using evidence-based services to help people quit using tobacco.

• Improved quality and availability of diabetes

• Improved health outcomes among people with diabetes.*

Step 1: Review the Opportunity 15

Strategies Short-term outcomes (1-2 years)

Intermediate outcomes (2-5 years)

Long-term outcomes (5 years or more)

NCD

Collaborative.* management and care services.*

5. Coordinate actions to increase access to, use of, and participation in evidence-based chronic disease prevention and management services.

• Increased awareness of the need to support and promote services to help people quit using tobacco via healthcare providers and partners.

• Increased establishment and maintenance of culturally tailored diabetes self-management education and support (DSMES) programs.*

• Increased implementation of culturally tailored, CDC-recognized type 2 diabetes prevention programs.*

• Increased engagement and coordination of partners to improve access to and use of culturally appropriate, evidence-based services to help people quit using tobacco.*

• Increased engagement in culturally tailored DSMES programs among adults with diabetes.*

• Increased participation in culturally tailored, CDC-recognized type 2 diabetes prevention programs among adults at high risk for type 2 diabetes.*µ

• Improved self-management among people with diabetes.*

• Reduced risk for type 2 diabetes among adults participating in culturally tailored, CDC-recognized type 2 diabetes prevention programs. *µ

* Indicates outcomes you are required to report on. You are only required to report on outcomes for the specific activities you have selected to work on.

µ Indicates outcomes for which CDC will provide data for linked performance measures.

Step 1: Review the Opportunity 16

Core Component strategies and activities This section elaborates on the strategies and activities described in the logic model and provides details on expectations of recipients to implement the NOFO. In describing your approach, you must include background information that supports the need for NCD prevention activities in your U.S.

territory or freely associated state. You must describe the strategies and activities you plan to implement during the period of performance.

We expect you to implement all five strategies in the Core Component during the five-year period of performance. Each strategy has different requirements for which activities you must implement. Some requirements involve more than one strategy.

You are welcome to select more than the required number of activities.

However, choosing additional activities will not impact your application score.

The summary of required activities provides a summary of the requirements for each strategy.

Strategy 1 Systematically collect, share, and use non-communicable disease (NCD) population-based and/or clinical data to drive local public health action and evaluate impact.

You must select at least two of these activities:

• 1.1: Develop and/or update your NCD surveillance plan and/or NCD data dashboard. If you are also applying for the Oral Health Component, you must incorporate oral health indicators and dissemination activities into the NCD surveillance plan and/or NCD data dashboard.

• 1.2: Conduct surveys, such as NCD hybrid survey, Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavioral System (YRBS), Global Youth Tobacco Survey (GYTS), and Global Adult Tobacco Survey (GATS).

• 1.3: Disseminate and use surveillance data to plan and implement your program.

You must implement activities 1.4 and 1.5:

• 1.4: Develop and/or maintain a jurisdiction NCD coalition that includes engaged, diverse members interested in working to prevent and reduce tobacco use and secondhand smoke exposure, prevent and manage diabetes, and improve oral health disparities (if you are applying for the Oral Health Component) through data-informed public health actions.

Step 1: Review the Opportunity 17

• 1.5: Work with the jurisdiction NCD coalition and other partners to develop and/or update a five-year NCD strategic plan that engages partners in planning, monitoring, and implementing strategies and activities.

Strategy 2 Implement policy, system, and environmental (PSE) change strategies to improve awareness and prevention of chronic disease and associated modifiable risk factors.

Activities for this strategy focus on tobacco prevention and control. You will educate and engage partners, decision-makers, and the public on the scientific evidence base for activities to prevent initiation of tobacco use or reduce exposure to secondhand smoke. Tobacco use includes e-cigarettes and betel nut with tobacco, where applicable.

Activities must be consistent with the permissible activities in CDC’s Anti- Lobbying Restrictions.

You must select at least one activity from either the youth prevention activities or the secondhand smoke reduction activities.

Youth prevention activities

You will educate partners, decision-makers, and the public on the scientific evidence-base for:

• 2.1: Establishing and strengthening tobacco-free policies in schools and on college and university campuses.

• 2.2: Raising the minimum age of tobacco sales to at least 21.

• 2.3: Strengthening licensing requirements to sell tobacco products, including e-cigarettes.

• 2.4: Prohibiting the sale of all flavored tobacco products (for example, combustibles and e-cigarettes), including menthol.

• 2.5: Restricting the location, number, type, or density of tobacco retailers through, for example, zoning or licensing requirements.

• 2.6: Reducing exposure to tobacco industry marketing.

• 2.7: Increasing the price of tobacco products, including e-cigarettes.

Evidence-based strategies could include taxes, prohibiting discounts and redemption coupons, and minimum price laws.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.cdc.gov/grants/documents/Anti-Lobbying-Restrictions.pdf https://www.cdc.gov/grants/documents/Anti-Lobbying-Restrictions.pdf

Secondhand smoke reduction activities

You will educate partners, decision-makers, and the public on the scientific evidence base for:

• 2.8: Increasing and enhancing comprehensive smokefree policies, including policies for workplaces, bars, restaurants, and casinos and gaming facilities.

• 2.9: Increasing tobacco-free policies in healthcare facilities and campuses, including behavioral health (mental health and substance use disorders) facilities.

Strategy 3 Implement culturally appropriate health communication approaches to prevent and/or control risk factors that lead to chronic disease.

Activities for this strategy focus on diabetes prevention and tobacco prevention and control.

Diabetes prevention

You must select a minimum of one activity for diabetes prevention from either Strategy 3 or Strategy 5. Choose either activity 3.1 or activity 5.1. You may also choose to work on both. You can learn more about activity 5.1 under diabetes prevention in Strategy 5.

• 3.1: Share information to raise awareness of prediabetes in both the general population and among healthcare professionals.

Tobacco prevention and control

You must select a minimum of one of the following tobacco prevention and control health communication activities. The activity you choose should communicate the evidence base for the policy activity you selected in Strategy 2.

• 3.2: Educate the public, partners, and decision-makers about the evidence base for interventions that prevent or help people to quit tobacco use, using data, earned media, and culturally appropriate paid media.

• 3.3: Educate and engage decision-makers and partners, such as parents, schools, and community-based organizations, on evidence-based strategies to reduce youth use of emerging tobacco products, including e-cigarettes.

Step 1: Review the Opportunity 19

• 3.4: Implement tailored and culturally appropriate evidence-based health communication strategies to reach population groups experiencing tobacco-related disparities.

• 3.5: Educate and engage the public, partners, and decision-makers on evidence-based strategies to reduce exposure to secondhand smoke using data, earned media, and culturally appropriate paid media.

Strategy 4 Promote health systems changes to improve screening, treatment, care, and support for people with and at risk for chronic disease.

Activities for this strategy focus on diabetes management and tobacco prevention and control.

Diabetes management

You must select a minimum of one diabetes management activity from either Strategy 4 or Strategy 5. Choose either activity 4.1 or activity 5.2. You can learn more about activity 5.2 under diabetes management in Strategy 5.

• 4.1: Partner with clinical teams through the Non-Communicable Disease (NCD) Collaborative to improve care for people with diabetes and address gaps in needed services.

Tobacco prevention and control

You must select a minimum of one tobacco prevention and control activity from either Strategy 4 or Strategy 5. Choose either activity 4.2, activity 4.3, activity 4.4, activity 5.3, or activity 5.4. To learn more about activity 5.3 and activity 5.4, see Strategy 5.

• 4.2: Engage healthcare providers and health systems to routinely screen for tobacco use, advise tobacco users to quit, and promote and support evidence-based quit services.

• 4.3: Engage healthcare providers and health systems to expand tobacco use screening and delivery of tobacco education and treatment for youth and young adults, including for e-cigarettes and betel nut with tobacco, where applicable.

• 4.4: Increase engagement with behavioral health and substance use disorder providers and behavioral health systems to address tobacco use and incorporate delivery of evidence-based services to help people quit using tobacco into the routine workflow.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 https://chronicdisease.org/cphl/resource-hub/non-communicable-disease-collaborative-diabetes-education-resources-pacific-island-english/#flipbook-u-s-associated-pacific-islands-non-communicable-disease-collaborative-handbook/1/ https://chronicdisease.org/cphl/resource-hub/non-communicable-disease-collaborative-diabetes-education-resources-pacific-island-english/#flipbook-u-s-associated-pacific-islands-non-communicable-disease-collaborative-handbook/1/

Strategy 5 Coordinate actions to increase access to, use of, and participation in evidence-based chronic disease prevention and management services.

Activities for this strategy focus on diabetes prevention, diabetes management, and tobacco prevention and control.

Diabetes prevention

You must select a minimum of one diabetes prevention activity from either Strategy 3 or Strategy 5. Choose either activity 3.1 or activity 5.1. You can learn more about activity 3.1 under diabetes prevention in Strategy 3.

• 5.1: Improve access to and participation in culturally tailored, CDC-recognized type 2 diabetes prevention programs by establishing new programs, supporting enrollment of participants in existing programs, or participating in National Diabetes Prevention Program (National DPP) umbrella hub arrangements where feasible.

Diabetes management

You must select a minimum of one diabetes management activity from either Strategy 4 or Strategy 5. Choose either activity 4.1 or activity 5.2. You can learn more about activity 4.1 under diabetes management in Strategy 4.

• 5.2: Improve access to and participation in culturally tailored diabetes self-management education and support (DSMES) programs.

Tobacco prevention and control

You must select a minimum of one tobacco prevention and control activity from either Strategy 4 or Strategy 5. Choose either activity 4.2, activity 4.3, activity 4.4, activity 5.3, or activity 5.4. To learn more about activity 4.2, activity 4.3, and activity 4.4, see Strategy 4.

• 5.3: Work with the NCD/tobacco control coalition and other partners to increase availability of culturally appropriate, evidence-based, or promising practice services to help people quit using tobacco.

• 5.4: Promote use of available evidence-based or promising practice services to help people quit using tobacco by educating healthcare professionals, allied health professionals, and patients.

Summary of required activities This table summarizes the requirements for all five strategies of the Core Component.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.cdc.gov/diabetes-prevention/?CDC_AAref_Val=https://www.cdc.gov/diabetes/prevention/index.html

Table: Required activities

Strategy Required activities Total number of required activities

Strategy 1 • Any two of:

◦ Activity 1.1

◦ Activity 1.2

◦ Activity 1.3

• Activity 1.4

• Activity 1.5

Four

Strategy 2 • Any one of:

◦ Activity 2.1

◦ Activity 2.2

◦ Activity 2.3

◦ Activity 2.4

◦ Activity 2.5

◦ Activity 2.6

◦ Activity 2.7

◦ Activity 2.8

◦ Activity 2.9

One

Strategy 3 • Any one of:

◦ Activity 3.2

◦ Activity 3.3

◦ Activity 3.4

◦ Activity 3.5

One

Diabetes prevention strategies (Strategies 3 and 5)

• Any one of:

◦ Activity 3.1

◦ Activity 5.1

One

Diabetes management strategies (Strategies 4 and 5)

• Any one of:

◦ Activity 4.1

◦ Activity 5.2

One

Tobacco prevention and control strategies (Strategies 4 and 5)

• Any one of:

◦ Activity 4.2

One

Step 1: Review the Opportunity 22

Strategy Required activities Total number of required activities

◦ Activity 4.3

◦ Activity 4.4

◦ Activity 5.3

◦ Activity 5.4

Core Component outcomes We expect you to report on the asterisked (*) short-term, intermediate, and long-term outcomes in the Core Component logic model by the end of the five-year period of performance. You will be required to report on performance measures linked to the asterisked outcomes that you select to work on. You must identify outcomes consistent with the outcomes in the program’s logic model.

This section lists all of the asterisked outcomes from the logic model.

Short-term outcomes

• Increased public and decision-maker awareness and knowledge of the risks of chronic disease, including the dangers of tobacco use, and the effectiveness of tobacco control interventions and social norm change.

• Increased awareness about benefits of smokefree environments and increased support for them.

• Increased reach of prediabetes awareness messages in the general population and among healthcare professionals.

• Increased health communication interventions and messages to reach both the general population and populations experiencing tobacco-related disparities.

• Increased health systems that routinely screen for tobacco use, advise tobacco users to quit, and promote and support evidence-based services to help people quit using tobacco.

• Increased engagement of clinical and public health team members in the NCD Collaborative.

• Increased establishment and maintenance of culturally tailored diabetes self-management education and support (DSMES) programs.

• Increased number of culturally tailored, CDC-recognized type 2 diabetes prevention programs.

Step 1: Review the Opportunity 23

Intermediate outcomes

• Decreased exposure to tobacco marketing.

• Increased implementation of tobacco control policies

• Increased implementation of comprehensive smokefree/tobacco-free policies.

• Increased smokefree environments.

• Reduced access to tobacco products and reduced social norms accepting of tobacco use.

• Increased engagement and coordination of partners to improve access to and use of culturally appropriate, evidence-based services to help people quit using tobacco.

• Improved quality and availability of diabetes management and care services.

• Increased engagement in culturally tailored DSMES programs among adults with diabetes.

• Increased participation in culturally tailored, CDC-recognized type 2 diabetes prevention programs among adults at high risk for type 2 diabetes. (CDC will provide data for this outcome.)

Long-term outcomes

• Improved self-management among people with diabetes.

• Improved health outcomes among people with diabetes.

• Reduced risk for type 2 diabetes among adults participating in culturally tailored, CDC-recognized type 2 diabetes prevention programs. (CDC will provide data for this outcome.)

• Decreased tobacco use among adults and adolescents.

Oral Health Component approach Overview The Oral Health Component is optional. You must apply for and be awarded the Core Component to be considered for the Oral Health Component.

The Oral Health Component strategies address oral health disparities by supporting interventions and practices to address oral disease in the U.S.

territories and freely associated states. Interventions must include:

• Oral health surveillance.

Step 1: Review the Opportunity 24

• Evidence-based preventive dental services (EBPDS). EBPDS are defined as only dental sealants and fluoride varnish for school-aged children.

• Infection prevention and control.

In describing your approach for this component, you must include background information that supports the need to reduce oral health disparities in your U.S. territory or freely associated state. You must describe the strategies and activities you plan to implement during the period of performance.

The following logic model includes the Oral Health Component’s strategies and activities under this NOFO. It also includes the program’s expected outcomes. The asterisked (*) outcomes are those we expect you to achieve during the five-year period of performance.

Oral Health Component logic model The logic model shows the strategies and activities of the program along with the outcomes we expect over time. We will require you to report on the asterisked (*) outcomes as follows.

Table: Oral Health Component strategies and outcomes

Strategies and activities Short-term outcomes Intermediate outcomes Long-term outcomes

1. Oral health surveillance:

Monitor the burden of oral diseases and access to preventive services, disseminate findings to inform program and policy decisions, and incorporate oral health data into existing surveillance systems and plans, where appropriate.

• Improved monitoring of oral health trends.

• Improved completeness and quality of oral health surveillance data.

• Increased dissemination of data on oral disease, risk factors (such as tobacco use or medical and dental visits among adults with Type 2 diabetes), and use

• Increased use of oral health data by decision-makers, partners, and the public.

• Reduced disparities in receipt of evidence-based preventive dental services (EBPDS) across populations with a large burden of oral health disparities.*

• Decreased untreated decay in populations with a large burden of health disparities.

Step 1: Review the Opportunity 25

Strategies and activities Short-term outcomes Intermediate outcomes Long-term outcomes of preventive oral health services.*

2. Evidence-based preventive dental services (EBPDS):

Identify high-need school and community settings requiring EBPDS. Use secondary data to enhance equitable access and delivery of EBPDS, particularly for populations experiencing oral health disparities.

• Increased implementation of EBPDS programs.

• Increased dissemination of information about the benefits of adopting EBPDS among decision-makers, parents, educators, and school administrators.

• Increased availability of and access to EBPDS programs.

3. Infection prevention and control (IPC):

Promote IPC in dental settings by fostering partnerships, conducting training, and advocating for the use of IPC guidelines and resources, particularly within programs serving communities experiencing oral health disparities.

• Increased awareness and use of dental IPC recommendations and resources, especially among EBPDS programs and other dental programs or facilities serving communities with oral health disparities.*

• Increased capacity of programs that serve populations with a large burden of health disparities to adhere to CDC IPC guidelines.

• Increased adherence to IPC Standard Precautions and other infection prevention recommendations, in both traditional and non-traditional dental settings.

* Indicates outcomes you are required to report on.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.cdc.gov/dental-infection-control/hcp/index.html https://www.cdc.gov/dental-infection-control/hcp/index.html https://www.cdc.gov/dental-infection-control/hcp/index.html https://www.cdc.gov/dental-infection-control/hcp/summary/standard-precautions.html https://www.cdc.gov/dental-infection-control/hcp/summary/standard-precautions.html https://www.cdc.gov/dental-infection-control/hcp/summary/standard-precautions.html

Oral Health Component strategies and activities This section elaborates on the strategies and activities described in the logic model and provides details on expectations of recipients to implement the

NOFO.

The Oral Health Component is optional. You must apply for the Core Component to be considered for the Oral Health Component.

If you want to apply for the Oral Health Component, submit only one application and make sure that you clearly identify the Core and Oral Health Components in your application. Applicants who do not receive funding through the Oral Health Component may still be eligible for funding under the Core Component if their application is successful.

We will only make one award under the Oral Health Component.

Once selected for award, the Oral Health Component recipient is expected to implement all three of the following strategies and all corresponding activities during the five-year period of performance. These strategies should be implemented in island school and community oral health programs, as appropriate.

Strategy 1 Oral health surveillance: Monitor the burden of oral diseases and access to preventive services, disseminate findings to inform program and policy decisions, and incorporate oral health data into existing surveillance systems and plans, where appropriate.

Activities

The following activities are required:

• 1.1: Incorporate oral health indicators and dissemination activities into the NCD surveillance plan to monitor the burden of oral disease and inform program and policy decisions.

1.2: Develop, maintain, and disseminate a document that describes the burden of oral disease, risk and protective factors affecting oral disease, and the provision of oral health dental services.

1.3: Analyze, interpret, and disseminate secondary data about relationships between the oral health of adults with Type 2 diabetes and their overall health, as well as their use of and access to medical and dental care. The goal of this activity is to support medical-dental integration efforts.

Step 1: Review the Opportunity 27

Strategy 2 Evidence-based preventive dental services (EBPDS): Identify high-need school and community settings requiring EBPDS. Use secondary data to enhance equitable access and delivery of EBPDS, particularly for populations experiencing oral health disparities.

You must identify schools and non-school settings (such as Community Health Centers or Head Start centers) with the highest need for EBPDS, in order to increase use of and access to preventive services. The goal of this strategy is to establish and maintain relationships with entities that can help reach populations with a large burden of health disparities.

In addition, you must collect and use data to inform efforts for and improve equitable access to EBPDS delivery programs in populations with a large burden of health disparities. Specifically, this approach aims to enhance program delivery across communities disproportionately experiencing barriers to oral health services or having an elevated risk of cavities. You must describe known barriers to oral health services and how you plan to overcome those barriers.

Activities

The following activities are required:

• 2.1: Use data analyses and program implementation data to identify EBPDS needs and expand access to EBPDS for school-aged children.

• 2.2: Build or use existing partnerships to increase EBPDS participation in populations and communities that disproportionately experience barriers to oral health services or have an elevated risk for cavities.

Strategy 3 Infection prevention and control (IPC): Promote IPC in dental settings by fostering partnerships, conducting training, and advocating for the use of IPC guidelines and resources, particularly within programs serving communities experiencing oral health disparities.

You must promote IPC in dental settings through establishing IPC partnerships, completing IPC training courses, and promoting the use of IPC trainings, guidelines, and other infection prevention resources. You must specifically promote the use of these trainings and resources among oral health programs serving EBPDS school programs, as well as other dental programs or facilities serving communities with oral health disparities.

You must expand your capacity for IPC in dental settings by establishing partnerships with organizations with expertise in IPC and a shared mission to

Step 1: Review the Opportunity 28 promote it. We require you to work with your jurisdiction’s Healthcare- Associated Infection (HAI) programs.

Activities

The following activities are required:

• 3.1: Promote dental IPC resources through new or existing partnerships with HAI programs and school and community organizations with oral health IPC expertise.

• 3.2: Implement activities that promote use of dental IPC resources.

• 3.3: Promote access to non-CDC infection control trainings and resources among island oral health staff. Funded recipients must promote the following CDC resources:

◦ CDC’s Summary of Infection Prevention Practices in Dental Settings

◦ Foundations: Building the Safest Dental Visit

• CDC DentalCheck Mobile App

Oral Health Component outcomes We expect you to achieve the asterisked (*) outcomes in the Oral Health Component logic model by the end of the five-year period of performance.

You must identify outcomes consistent with those in the program’s logic model. See the Oral Health Component logic model for a full list of outcomes.

Short-term outcomes

• Increased dissemination of data on oral disease, risk factors (for example, medical and dental visits among adults with Type 2 diabetes), and use of preventive oral health services.

• Increased awareness and use of dental IPC recommendations and resources, especially among EBPDS programs and other dental programs or facilities serving communities with oral health disparities.

Intermediate outcomes Increased availability of and access to EBPDS programs.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 29 https://www.cdc.gov/healthcare-associated-infections/programs/?CDC_AAref_Val=https://www.cdc.gov/hai/hai-ar-programs/recipients-funding.html https://www.cdc.gov/healthcare-associated-infections/programs/?CDC_AAref_Val=https://www.cdc.gov/hai/hai-ar-programs/recipients-funding.html https://www.cdc.gov/dental-infection-control/hcp/summary/?CDC_AAref_Val=https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/index.html https://www.cdc.gov/dental-infection-control/hcp/training/?CDC_AAref_Val=https://www.cdc.gov/oralhealth/infectioncontrol/foundations-building-the-safest-dental-visit.html https://www.cdc.gov/dental-infection-control/hcp/cdcdentalcheck/?CDC_AAref_Val=https://www.cdc.gov/oralhealth/infectioncontrol/dentalcheck.html

Focus populations This NOFO will serve populations living in the eight U.S. territories and freely associated states.

Describe the specific population or populations you plan to address under this award. Explain how you will include them and meet their needs in your project. Describe how your work will benefit public health and the populations and alleviate health disparities.

Equal opportunities This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Health disparities are often caused by social determinants that influence which populations are most disproportionately affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age. These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks.

The U.S. territories and freely associated states face a unique set of challenges due to their geographic location, land topography, and accessibility to resources. Additionally, they are shaped by distinct cultural and historical practices that influence health behaviors and outcomes. Some of these contributing factors include:

• Social determinants of health: Historical traumas such as colonialism have contributed to poverty, unemployment, and poor housing. These conditions are known to increase the risk for unhealthy behaviors and chronic diseases.

• Natural disasters: Typhoons and hurricanes often result in loss of water, electricity, housing, and health services.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

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