Foa_Content_of_CDC-RFA-DP-24-0056.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Building Capacity to Increase Commercial Tobacco Cessation

CDC-RFA-DP-24-0056

04/24/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 24-0056. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR)

B. Notice of Funding Opportunity (NOFO) Title:

Building Capacity to Increase Commercial Tobacco Cessation

C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-24-0056

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

E. Assistance Listings Number:

93.348

F. Dates:

1. Due Date for Letter of Intent (LOI):

03/20/2024

2. Due Date for Applications:

04/24/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

An informational call will be held on Friday, March 15, 2024 1:00 PM-2:00 PM EST

Information for the call can be found below:

Topic: DP-24-0056 NOFO Informational Meeting

Time: Mar 15, 2024 01:00 PM Eastern Time (US and Canada)

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Meeting ID: 160 761 4590

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Information related to this funding opportunity is available:

https://www.cdc.gov/tobacco/about/foa/increase-tobacco-cessation-nofo/index.html

Any questions should be sent to is cessationdp240056@cdc.gov and will be answered under the Frequently Asked Questions section online.

G. Executive Summary:

1. Summary Paragraph The CDC’s Office on Smoking and Health (OSH) is the lead federal entity for comprehensive commercial tobacco prevention and control. OSH seeks applicants to provide training and technical assistance to build capacity of National Tobacco Control Program (NTCP) recipients and their partners to translate the science of tobacco cessation into public health action with a focus on eliminating tobacco-related disparities and advancing health equity. This contributes to ensuring programs effectively work on strategies that increase quit attempts and successful cessation.

This multi-component funding announcement will award three applicants to support capacity building for the following evidence-based cessation interventions, prioritizing strategies that reach populations experiencing tobacco-related disparities:

Component 1: Improving state quitlines’ infrastructure, operations, and services to further enhance their effectiveness and efficiency; increasing state quitlines’ reach; broadening the range of cessation services offered by state quitlines; and enhancing quitline sustainability.

Component 2: Promoting and supporting implementation of health systems change initiatives that seek to integrate tobacco dependence treatment into routine clinical care across clinical settings.

Component 3: Promoting and supporting improvements to health insurance coverage for evidence-based tobacco cessation treatments (including individual, quitline, and group counseling and FDA-approved medications).

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards One award will be made per component.

Organizations may apply for more than one component, but a separate narrative and budget must be submitted for each component. Narrative submissions for each component will be reviewed independent of one another and should not reference the other application.

d. Total Period of Performance Funding:

$4,500,000

e. Average One Year Award Amount:

https://www.cdc.gov/tobacco/about/foa/increase-tobacco-cessation-nofo/index.html mailto:cessationdp240056@cdc.gov https://www.cdc.gov/tobacco/stateandcommunity/tobacco-control/index.htm

$300,000 It is anticipated that each award will be approximately $300,000 per year. Final award amount will be dependent on the availability of federal funding.

f. Total Period of Performance Length:

5 year(s)

g. Estimated Award Date:

August 30, 2024

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Commercial tobacco use is the leading preventable cause of disease, disability, and death in the United States. Cigarette smoking prevalence among adults in the United States declined from 20.9% in 2005 to 12.5% in 2020. However, more than 30 million U.S. adults currently smoke, and disparities in smoking persist among: certain racial and ethnic groups; persons with lower socioeconomic status (SES); people living with mental health conditions and/or substance use disorders; persons with a disability or limitation; persons identifying as lesbian, gay, bisexual, or transgender; and persons without health insurance or with Medicaid coverage.

Encouraging and helping people who use tobacco to quit can reduce tobacco-related disease, death, and health care costs. About 70 percent of adults who smoke want to quit, and more than half try to quit each year. The use of evidence-based tobacco cessation treatments, including cessation counseling and medication, can substantially increase the odds that people who smoke will quit successfully. However, fewer than one third of adults who smoke use evidence-based treatments when trying to quit.

Increasing access to proven cessation treatments increases quit rates among people who smoke cigarettes. These proven cessation treatments include individual, group, and telephone cessation counseling, seven Food and Drug Administration (FDA)-approved cessation medications, and web- and text-based interventions. While counseling and medication are independently effective, these treatments are most effective when they are combined.

The funding under this announcement is aimed at improving public health outcomes by strengthening public health infrastructure, specifically, the National Tobacco Control Program (NTCP) workforce through training and technical assistance that aligns with the three broad goals for state tobacco control programs’ cessation activities described in the 2014 edition of CDC’s Best Practices for Comprehensive Tobacco Control Programs and in the 2020 CDC Best Practices User Guide: Cessation in Tobacco Prevention and Control:

https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/2014/comprehensive.pdf https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/2014/comprehensive.pdf https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/best-practices-cessation-user-guide-508.pdf https://www.cdc.gov/tobacco/stateandcommunity/guides/pdfs/best-practices-cessation-user-guide-508.pdf

• Supporting state quitlines: Proactive quitlines that offer free counseling services provided by trained coaches who follow standardized protocols have been shown to be effective among people who smoke in general and several specific populations. Digital technologies (including web, text messaging, chat, and apps) have the potential to expand access to cessation services, especially among young adults who may be accustomed to using these technologies and may prefer receiving cessation assistance through these modalities.

• Promoting health systems change to integrate evidence-based tobacco dependence treatment into routine clinical care: Health care providers play an important role in helping smokers quit. Well-established clinical cessation approaches exist that also include connecting patients to cessation services, such as a quitline, for more intensive assistance.

• Improving insurance coverage of evidence-based cessation treatments and increasing use of these treatments: Insurance coverage for smoking cessation treatment that is comprehensive, barrier-free, and widely promoted increases the use of cessation treatment services, leads to higher rates of successful quitting, and is cost-effective.

This NOFO will build on the successes of the CDC-RFA-DP19-1904 Technical Assistance to Increase Tobacco Cessation and the CDC-RFA-DP-DP 13-1316 Consortium for Tobacco Use Cessation Technical Assistance.

b. Statutory Authorities Section 301(a) of the PHS Act, 42 U.S.C. Section 241(a)

c. Healthy People 2030

• Increase past-year attempts to quit smoking in adults — TU-11 - Healthy People 2030 | health.gov

• Increase the proportion of adults who get advice to quit smoking from a health care provider — TU-12 - Healthy People 2030 | health.gov

• Increase use of smoking cessation counseling and medication in adults who smoke —

TU-13 - Healthy People 2030 | health.gov

• Increase Medicaid coverage of evidence-based treatment to help people quit using tobacco — TU-16 - Healthy People 2030 | health.gov

• Increase abstinence from cigarette smoking among pregnant women — MICH-10 -

Healthy People 2030 | health.gov

d. Other National Public Health Priorities and Strategies

• The Government Performance Results Modernization Act Long-term Objective. 4.6:

Reduce Death and Disability Due to Tobacco and 4.6.3: Reduce the proportion of adults who are current cigarette smokers.

• Department of Health & Human Services Strategic Plan (Strategic Objective 1.2:

Reduce costs, improve quality of healthcare services, and ensure access to safe medical devices and drugs; Strategic Objective 2.3: Enhance promotion of healthy behaviors to reduce occurrence of and disparities in preventable injury, illness, and death; White House Cancer Moonshot Initiative Cancer Moonshot | The White House

e. Relevant Work https://www.grants.gov/search-results-detail/313436 https://www.grants.gov/search-results-detail/313436 https://www.grants.gov/search-results-detail/236157 https://www.grants.gov/search-results-detail/236157 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-past-year-attempts-quit-smoking-adults-tu-11 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-past-year-attempts-quit-smoking-adults-tu-11 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-proportion-adults-who-get-advice-quit-smoking-health-care-provider-tu-12 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-proportion-adults-who-get-advice-quit-smoking-health-care-provider-tu-12 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-use-smoking-cessation-counseling-and-medication-adults-who-smoke-tu-13 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-use-smoking-cessation-counseling-and-medication-adults-who-smoke-tu-13 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-medicaid-coverage-evidence-based-treatment-help-people-quit-using-tobacco-tu-16 https://health.gov/healthypeople/objectives-and-data/browse-objectives/tobacco-use/increase-medicaid-coverage-evidence-based-treatment-help-people-quit-using-tobacco-tu-16 https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-abstinence-cigarette-smoking-among-pregnant-women-mich-10 https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-abstinence-cigarette-smoking-among-pregnant-women-mich-10 https://www.hhs.gov/about/strategic-plan/2022-2026/goal-1/objective-1-2/index.html https://www.hhs.gov/about/strategic-plan/2022-2026/goal-2/objective-2-3/index.html https://www.whitehouse.gov/cancermoonshot/

Those receiving funding under this award will build on the successes of the 2019 NOFO – DP19-1904 Technical Assistance to Increase Tobacco Cessation and the 2013 NOFO — DP 13-1316 Consortium for Tobacco Use Cessation Technical Assistance.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

The strategies and activities described throughout this logic model should intentionally address and prioritize strategies aimed at increasing cessation by those population groups disproportionately impacted by tobacco use and cessation-related disparities.

Strategies/Activities

SHORT-TERM

OUTCOMES

INTERMEDI

ATE

LONG-TERM

All components:

• Identify relevant competencies

• Assess knowledge, skills and abilities of training and technical assistance recipients related to identified competencies

• Use assessment to plan, develop, promote, and deliver appropriate technical assistance and trainings.

• Develop/Utilize mechanisms to facilitate learning, document, and share information and knowledge that includes best and

All Components:

Increased networking, partnerships, and coordination among training and technical assistance providers.

Increased awareness of resources related to effective tobacco cessation strategies.

Component 1:

Increased utilization of training and technical assistance opportunities and resources related to strategies to improve and support quitline services.

Increased knowledge and understanding of

Component 1:

Increased application of approaches that improve and support quitline services.

Component 2:

Increased application of approaches that promote and support cessation within health care systems.

Component 3:

application of approaches to improve health insurance coverage for evidence-based

Increased adoption and implementation of strategies aimed at supporting and increasing utilization of quitlines, particularly among populations experiencing tobacco-related disparities.

Increased delivery of cessation treatment by health care providers and systems, particularly to population groups experiencing tobacco use and cessation-related disparities.

Improved health insurance coverage for tobacco cessation treatments.

Increased utilization of evidence-based cessation treatments;

Increased attempts to quit tobacco.

https://www.grants.gov/search-results-detail/313436 https://www.grants.gov/search-results-detail/236157 https://www.grants.gov/search-results-detail/236157 promising practices, experiences, and lessons learned.

• Develop and implement project evaluation and performance plan.

strategies to improve and sustain quitline

Component 2:

utilization of training and technical assistance opportunities and resources related to strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment.

Increased knowledge and understanding of strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment.

Component 3:

utilization of training and technical assistance opportunities and resources related to strategies to tobacco cessation treatments.

Distal Outcomes

• Increased cessation of tobacco as early in life as possible.

• Decreased tobacco use prevalence and consumption.

• Decreased disparities in tobacco cessation and tobacco use.

improve health insurance coverage for evidence-based tobacco cessation treatments.

Increased knowledge and understanding of strategies to improve health insurance coverage for evidence-based tobacco cessation treatments.

i. Purpose The purpose of this cooperative agreement is to build capacity of National Tobacco Control Program (NTCP) recipients and their partners by providing training and technical assistance on public health tobacco cessation interventions aimed at increasing the number of people who try to quit using tobacco products and who succeed in quitting. Activities under this award should be focused on prioritizing interventions that reach population groups disproportionately impacted by tobacco use and cessation-related disparities. Visit the website to learn more about the National Tobacco Control Program.

ii. Outcomes Short Term

Component 1:

• Increased utilization of training and technical assistance opportunities and resources related to strategies to improve and support quitline services.

• Increased knowledge and understanding of strategies to improve and support quitline services.

Component 2:

• Increased utilization of training and technical assistance opportunities and resources related to strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment.

• Increased knowledge and understanding of strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment.

Component 3:

• Increased utilization of training and technical assistance opportunities and resources related to strategies to improve health insurance coverage for evidence-based tobacco cessation treatments.

• Increased knowledge and understanding of strategies to improve health insurance coverage for evidence-based tobacco cessation treatments.

Intermediate:

Component 1:

• Increased application of approaches that improve and support quitline services.

Component 2:

• Increased application of approaches that promote and support cessation within health care systems.

Component 3:

• Increased application of approaches to improve health insurance coverage for evidence-based tobacco cessation treatments.

iii. Strategies and Activities The following applies to all components unless indicated (Component 1, 2, 3)

In providing training and technical assistance, recipients are expected to prioritize training and technical assistance on interventions that reach population groups disproportionately impacted by tobacco use and cessation-related disparities and aimed at advancing health equity.

Recipients will be expected to address all of the following activities during the period of performance.

1. Identify relevant competencies

a. Consider the required strategies and activities of National Tobacco Control Program (NTCP) recipients currently funded under DP20-2001, as applicable, when developing competencies. Engage with CDC and other interested parties (i.e., tobacco control program managers and program staff, national tobacco control partners, healthcare providers and insurers, quitline providers) to ensure competencies meaningfully describe capacity expectations for tobacco control program staff.

b. Establish a process and timeline to routinely review competencies for any revisions/additions.

c. Consider the following topics by component when developing competencies for which training and technical assistance opportunities will be developed and implemented:

Component 1:

Provide technical assistance and training to NTCP recipients and their partners on:

• quitline operations including, but not limited to: developments in service delivery models including related to various technology (web, text messaging, chat, apps, social media); stand-alone pharmacotherapy; re-engaging past quitline users in cessation activities by re-contacting them; providing services to youth; establishing mechanisms for direct referral; and contingency management.

• identifying and disseminating best practices for maximizing the equitable reach and impact of state quitlines.

• strategies to ensure sustainability of state quitlines (i.e. public-private partnerships and the CMS Medicaid quitline administrative match).

• strategies to leverage 1-800-QUIT-NOW; 1-855-DÉJELO-YA; the national Asian language quitline; the national texting portal “QuitNow” (333888); and the CDC’s Tips From Former Smokers® (Tips®) campaign.

• program evaluation and survey questionnaire development and implementation

• evaluating and responding to the impact of policies that relate to the provision of cessation services through quitlines.

Component 2:

Provide technical assistance and training to state tobacco control programs and their partners on:

• how to work with health care delivery systems to integrate routine screening of all patients for tobacco use and delivery of treatment for tobacco use and dependence into the clinical workflow via implementation of systems changes (including, but not limited to, protocol development, workflow redesign, integration of robust screening and cessation components into electronic health records, establishing systems to refer patients to quitlines and other cessation treatment resources, including through the use of e-referrals. See Million Hearts® Tobacco Cessation Change Package

• evaluating the impact of health systems changes on cessation outcomes.

• evaluating and responding to the impact of policies that relate to the provision of cessation services through health systems (e.g., tobacco control and healthcare policies, CMS Medicaid rules).

Component 3:

Provide technical assistance and training to state tobacco control programs and their partners on:

• types of health insurance coverage and how tobacco cessation treatment is or is not covered and requirements for reimbursement processes, including barriers.

• strategies to improve health insurance coverage of evidence-based cessation treatments, including removing barriers.

• processes and partnerships for regulating health insurance coverage (including laws and regulations related to health insurance and their enforcement).

• working with payors and purchasers of health insurance (especially Medicaid) on opportunities and mechanisms to improve coverage through revisions.

• measuring utilization and the impact of health insurance coverage for cessation treatment.

• evaluating and responding to the impact of policies that relate to the health insurance coverage for cessation services (e.g. private and public payor insurance plan coverage of counseling and FDA-approved cessation medications; barriers to accessing coverage such as co-pays, stepped-therapy, annual limits, recognized provider types).

tel:1-855-335-3569 https://millionhearts.hhs.gov/tools-protocols/action-guides/tobacco-change-package/index.html#what

2. Assess knowledge, skills and abilities of training and technical assistance recipients related to identified competencies.

a. When available, leverage existing data for this assessment (i.e., CDC NTCP program assessments/reports, literature) and/or use key informants. Independent assessments and interviews can also be developed and implemented. Coordination with CDC OSH and other technical assistance providers should be considered as part of this process.

3. Use assessment to plan, develop, promote, and deliver appropriate technical assistance and trainings.

a. All recipients should develop a training and technical assistance (T/TA) plan that uses an initial assessment and planned periodic assessments. The plan should include, at minimum:

• topic(s) and competency(ies) addressed

• format/mechanism for delivery

• training materials (developing or existing)

• timeline

• staff responsible/partners

• learning objectives

• format/mechanism and timeline for assessments

b. The T/TA plan should be flexible to allow for changing needs of NTCP recipients and their partners. All recipients will be expected to follow the CDC Quality Training Standards to effectively develop trainings.to effectively develop trainings.

c. All recipients should provide descriptions of T/TA opportunities to CDC OSH and other technical assistance partners as appropriate to increase awareness and provide further promotion.

d. Recipients should consider appropriate mechanisms for delivery of training and technical assistance, such as conducting individual conference calls, workgroup meetings, discussion groups, trainings (in-person/virtual), and other activities that facilitate peer-to-peer learning.

4. Develop/Utilize mechanisms to facilitate learning, documentation, and sharing information and knowledge that includes best and promising practices, experiences, and lessons learned.

a. Based on the training and technical assistance topics described above for the relevant component, the recipient should utilize various mechanisms to facilitate information sharing on best practices, accomplishments, and lessons learned. These should include, as appropriate:

• guidance documents

• case studies

• tools

• recorded webinars or discussions (i.e., podcasts)

• peer reviewed journal publications

• conference presentations (including posters) https://www.cdc.gov/training/development/standards/index.html

• other products that will enhance the sustainability of training and technical assistance for future capacity building efforts and to expand the reach to the broader public health community and engaged and interested groups.

b. Access to these mechanisms should be made available as widely as possible (i.e. online, with additional dissemination to others for consideration to promote). Any recorded trainings that are available online should also be submitted to CDC TRAIN for consideration to include in their library.

5. Develop and implement project evaluation and performance plan.

*This activity will be addressed in the section under Evaluation and Performance Measurement

1. Collaborations

a. With other CDC projects and CDC-funded organizations:

The following applies for all components (Components 1,2, and 3)

Recipients will be expected to collaborate, as appropriate, with other programs at CDC (including their funded projects and programs) that are implementing and/or promoting quitline, health systems change, and health insurance coverage strategies related to, or with the potential to include, tobacco, as well as other CDC-funded national organizations that are providing technical assistance to NTCP recipients and national partners. This includes, but is not limited to, the other recipients of DP-24-0056 and the recipients of CDC-RFA-DP-23-0015: CDC’s National Networks Driving Action: Preventing Tobacco- and Cancer-Related Health Disparities by Building Equitable Communities

Recipients will be expected to participate in meetings and calls with other CDC-funded training and technical assistance providers to facilitate communication, cooperation, coordination, potential collaboration.

MOUs or MOAs are not required.

b. With organizations not funded by CDC:

The following applies for all components (Components 1,2, and 3)

Recipients will be expected to collaborate with organizations that have a role in conducting the proposed activities and achieving the NOFO outcomes. Recipients will be expected to work closely with certain national tobacco control organizations, including nongovernmental organizations as well as governmental agencies, to coordinate with these organizations in providing joint technical assistance to states and national partners on cessation topics, as well as avoiding duplication of efforts. MOUs or MOAs are not required.

2. Population(s) of Focus The following applies for all components (Components 1,2, and 3)

This NOFO aims to increase capacity among the National Tobacco Control Program (NTCP) recipients and their partners to promote and support policy, systems, and environmental strategies to address and prevent disparities related to tobacco cessation and to advance health equity (described in section, Health Disparities).

https://cdc.train.org/cdctrain/welcome

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.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

The following applies for all components (Components 1,2, and 3)

Although significant declines in cigarette smoking have occurred among adults overall over the past several decades, disparities in tobacco use persist among certain groups, including certain racial and ethnic groups, persons with low socioeconomic status, persons living with behavioral health conditions, persons with a disability or limitation, lesbian, gay, and bisexual persons, and persons without health insurance or with Medicaid coverage.

Activities funded under this announcement for training and technical assistance should address increasing capacity of state tobacco control programs and their partners to identify, promote, implement, and evaluate specific strategies for increasing, at minimum, these listed populations' access to and use of proven cessation treatments and services through state quitlines, health systems, and health insurance coverage.

This award should include training and technical assistance to NTCP recipients and their partners on how to identify, reach, and engage disproportionately affected populations to achieve the greatest health impact and advance health equity. For example, identifying and addressing the drivers of tobacco- and cessation-related disparities, including barriers to cessation treatment access and utilization and the social determinants of health which contribute to those barriers.

Additionally, recipients should promote preferred terms for select population groups to ensure accurate and non-stigmatizing language, including use of person-first language. Health Equity Guiding Principles for Inclusive Communication

iv. Funding Strategy This announcement will fund three distinct entities. Applicants may apply for more than one component but must submit separate narratives, work plans, and budgets for each component.

https://www.cdc.gov/healthcommunication/Health_Equity.html https://www.cdc.gov/healthcommunication/Health_Equity.html

Each narrative, work plan, and budget should be independent of the other (i.e., separate staffing/program structure). If an organization receives more than one award, some aspects of each award may be leveraged across awards/components, as appropriate per CDC’s approval.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The following applies to all components (Components 1, 2, 3)

The evaluation and performance measurement strategy for this NOFO is intended to measure the effectiveness of Training and Technical Assistance (T/TA), aligning with five stages of T/TA described in IS YOUR TRAINING AND TECHNICAL ASSISTANCE (T/TA) EFFECTIVE?

CONSIDERATIONS FOR MEASURING PERFORMANCE:

1. Content development - What are T/TA providers doing? Does the material provide the correct information?

2. Use – Is the T/TA that is offered used by the intended audience?

3. Response - Are users satisfied with the T/TA?

4. Learning - What do T/TA users learn?

5. Results - Can T/TA users apply what they learn on the job?

The above questions related to the T/TA stages form the basis for the performance measures and should be considered in developing overall project strategy and specific related performance measures applicants describe in their narrative and work plan. They should also be considered in developing evaluation questions and subsequent evaluation plan.

Over the course of this cooperative agreement CDC will use performance measures outlined in the table below to determine progress towards achieving the outcomes of this NOFO. The recipient and CDC are expected to use these measures and other evaluation findings for continuous program quality improvement across the period of performance. CDC will also use performance measures and evaluation findings to assess recipient compliance with the requirements of this NOFO, making budgetary decisions, and informing additional training and technical assistance.

This NOFO does not involve the generation or collection of public health data, therefore, a Data Management Plan is not required for this NOFO.

Outcome Performance Measure

Component 1 (Short-Term)

Increased utilization of training and technical assistance opportunities and resources related to strategies to improve and support quitline services

Increased knowledge and understanding of strategies to

• The number and reach of innovative products (e.g., briefs, webcasts, podcasts, toolkits, etc.)

related to strategies to improve and support quitline services a) developed and/or b) delivered to persons receiving technical assistance and training, especially NTCP recipients and their partners.

• The percentage (%) of participants reporting improved knowledge and understanding in knowledge of quitlines and strategies to improve https://aspe.hhs.gov/sites/default/files/private/aspe-files/261886/measuring-t-ta-considerations-toolkit.pdf https://aspe.hhs.gov/sites/default/files/private/aspe-files/261886/measuring-t-ta-considerations-toolkit.pdf improve and support quitline services and support quitline services as documented by before and after knowledge checks among persons receiving technical assistance and training, especially from state tobacco control programs and their partners.

Component 1 (Intermediate)

Increased application of approaches that improve and support quitline

• The number and description of examples, especially from NTCP recipients and their partners, applying approaches that improve and support quitline services.

Component 2 (Short-Term)

Increased utilization of training and technical assistance opportunities and resources related to strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment.

Increased knowledge and understanding of strategies to improve health systems’ support and ability to identify patients.

• The number and reach of innovative products (e.g., briefs, webcasts, podcasts, toolkits, etc.)

related to strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment a) developed and/or b) delivered to persons receiving technical assistance and training, especially state tobacco control programs and their partners.

• The percentage (%) of participants reporting improved knowledge and understanding in knowledge of strategies to improve health systems’ support and ability to identify patients who use tobacco and deliver cessation treatment as documented by before and after knowledge checks among persons receiving technical assistance and training, especially from state tobacco control programs and their partners.

Component 2 (Intermediate)

Increased application of approaches that promote and support cessation within health care systems.

• The number and description of examples, especially from state tobacco control programs and their partners applying approaches that promote and support cessation within health care systems.

Component 3 (Short-Term)

Increased utilization of training and technical assistance opportunities and resources related to strategies to improve health insurance coverage

• The number and reach of innovative products (e.g., briefs, webcasts, podcasts, toolkits, etc.)

related to strategies to improve health insurance coverage for evidence-based tobacco cessation treatments a) developed and/or b) delivered to persons receiving technical for evidence-based tobacco cessation treatments.

Increased knowledge and understanding of strategies to improve health insurance coverage for evidence-based tobacco cessation treatments.

assistance and training, especially state tobacco control programs and their partners.

• The percentage (%) of participants reporting improved knowledge and understanding related to improving health insurance coverage for evidence-based tobacco cessation treatments as documented by before and after knowledge checks among persons receiving technical assistance and training, especially from state tobacco control programs and their partners.

Component 3 (Intermediate)

Increased application of approaches to improve health insurance coverage for evidence-based tobacco cessation treatments.

• The number and description of examples, especially from NTCP recipients and their partners applying approaches that improve health insurance coverage for evidence-based tobacco cessation treatments.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

• How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement, including, as applicable to the award, how findings will contribute to reducing or eliminating health disparities and inequities.

• How key program partners will participate in the evaluation and performance measurement planning processes.

• Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant).

• How evaluation findings will be disseminated to communities and populations of interest in a manner that is suitable to their needs.

• Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

https://www.cdc.gov/grants/additional-requirements/ar-25.html

• Describe the type of evaluations (i.e., process, outcome, or both).

• Describe key evaluation questions to be addressed by these evaluations.

• Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO.

The following applies to all components (Component 1,2,3)

Applicants must provide an evaluation and performance measurement plan that demonstrates how they will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

• How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement, including, as applicable, how findings will contribute to reducing or eliminating health disparities and inequities.

• How key program partners will participate in the evaluation and performance measurement planning processes. Recipients will be expected to engage participants and partners in developing the final evaluation plan. Additional information regarding engaging collaborators in evaluation can be found in CDC’s Framework for Program Evaluation(resource Self-Study Guide - Program Evaluation - CDC https://www.cdc.gov/evaluation/guide/index.htm)

• Describe available or propose data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant).

• How evaluation findings will be disseminated to participants and engaged parties.

The following evaluation questions should be included in addition to questions related to meeting outcomes and performance measures:

a. To what extent has the recipient contributed to increasing networking, partnerships, and coordination among CDC-funded T/TA providers?

b. To what extent did the training and technical assistance activities implemented by the recipient reach NTCP recipients and their partners?

c. What aspects of T/TA contributed to the T/TA participants’ ability to change systems that have the potential to impact those populations experiencing cessation-related disparities?

Additional evaluation questions may be identified by the recipient and participants and engaged parties that should be included in the evaluation plan as the plan is developed.

Recipients will be required to develop and submit a final evaluation plan within 6 months of receiving the award.

CDC OSH will work with recipients to ensure that the evaluation plans are focused on the outcomes and performance measures identified in the NOFO as well as areas to focus on quality improvement.

https://www.cdc.gov/evaluation/guide/index.htm https://www.cdc.gov/evaluation/guide/index.htm https://www.cdc.gov/evaluation/guide/index.htm https://www.cdc.gov/evaluation/guide/index.htm

c. Organizational Capacity of Recipients to Implement the Approach The following applies to all components unless indicated (Component 1, 2, 3)

Applicants must describe organizational capacity that includes:

• An understanding of evidence-based tobacco control approaches and best practices for comprehensive state tobacco control programs, including strategies to address tobacco related disparities and ability to identify strategic opportunities based on the changes in the tobacco cessation and health care landscape.

• An in-depth knowledge of the science of tobacco addiction and cessation and effective tobacco cessation interventions and treatments, as well as specific knowledge and understanding of the topic under the component for which the applicant is applying:

quitlines (Component 1), health systems change (Component 2), or health insurance coverage (Component 3).

• An established track record of providing and evaluating technical assistance and training related to the tobacco cessation interventions for component for which the applicant is applying: quitlines (Component 1), health systems change (Component 2), or health insurance coverage (Component 3) to state tobacco control programs and national tobacco control organizations on a national scale.

• Adequate infrastructure and capacity to implement the project and achieve the project outcomes, including the ability to provide technical assistance on tobacco cessation issues to NTCP recipients and national tobacco control organizations on a nationwide basis.

Applicants must provide a project management/staffing plan that:

1. Indicates appropriate staff member experience for proposed work plan activities

2. Demonstrates clearly defined roles for staff members

3. Describes sufficient staff member capacity to accomplish program goals

(including cvs or resumes for identified staff that demonstrate (Applicants must name this file "CVs/Resumes" or "Organizational Charts" and upload it at www.grants.gov. Attachments can be submitted using PDF, Word, or Excel file formats)

4. Describes a financial management system that will allow for proper funds management and segregation of funds by program, and meet the requirements as stated in the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards

• Existing relationships with state tobacco control programs and/or national tobacco control organizations. Provide at least three letters of support that describe the nature of the existing relationship, including two from state tobacco control programs that have received training and technical assistance from the applicant and one from a national organization that works in tobacco control. (Applicants must name this file "Letters of Support" and upload it at www.grants.gov. Attachments can be submitted using PDF, Word, or Excel file formats).

d. Work Plan The following applies to all components (Components 1, 2, 3) http://www.grants.gov https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.302 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75#75.302 http://www.grants.gov

The applicant should submit a work plan that aligns with the performance measures and includes the following:

• specific measurable outcomes

• activities to achieve stated outcomes

• responsible position/party

• reasonable timelines

A sample work plan format is presented below to show how a traditional work plan aligns with the logic model and narrative. Although this format is not required, the elements in the sample are required. Period of Performance outcomes and measures should be provided for the 5-year period, however, the remainder of the work plan should reflect the first budget year.

In this sample format the table would be completed for each period of performance outcome.

If a particular activity leads to multiple outcomes, it should be described under each outcome measure.

Period of Performance Outcome:

[from Outcomes section and/or logic model]

Outcome Measure:

[from Evaluation and Performance

Measurement section]

Activities Process Measure

[from Evaluation and

Performance

Measurement section]

Responsible

Position /

Party

Completion

Date

1.

2.

3.

4.

5.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

• Tracking recipient progress in achieving the desired outcomes.

• Ensuring the adequacy of recipient systems that underlie and generate data reports.

• Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

• Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

• Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

• Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

• Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

Recipients for all components (Components 1,2,3) may be required to enter work plan and performance measures into an electronic Management Information System at some point throughout the period of performance. If this occurs, CDC will provide additional information through the annual continuation guidance and provide assistance as needed.

f. CDC Program Support to Recipients

To assist recipients for all components…