Foa_Content_of_RFA-DP-24-138 Modification.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Demonstration Projects to Research and Evaluate Strategies Aligned with CDC’s What Works in

Schools Approach

RFA-DP-24-138

03/11/2024

Table of Contents Section I. Funding Opportunity Description

Section II. Award Information

Section III. Eligibility Information

Section IV. Application and Submission Information

Section V. Application Review Information

Section VI. Award Administration Information

Section VII. Agency Contacts

Section VIII. Other Information

Overview Participating Organization(s) Centers for Disease Control and Prevention Components of Participating Organizations Components of Participating Organizations:

National Center for Chronic Disease Prevention and Health Promotion Notice of Funding Opportunity (NOFO) Title Demonstration Projects to Research and Evaluate Strategies Aligned with CDC’s What Works in Schools Approach Activity Code U01

Notice of Funding Opportunity Type New Agency Notice of Funding Opportunity Number

RFA-DP-24-138

Assistance Listings Number(s) 93.941 Category of Funding Activity HL - Health NOFO Purpose This Notice of Funding Opportunity (NOFO) supports research to implement and evaluate strategies aligned with CDC’s What Works in Schools (WWIS) approach for successful implementation in local education agencies and schools serving rural or American Indian and/or Alaska Native (AI/AN) adolescents to address students’ health behaviors, experiences, and outcomes, particularly those related to sexual and reproductive health and mental and behavioral health, as well as suicidality, substance use, and experiences of violence. The purpose of the research is to build the evidence base for innovative, school-based or school-linked strategies that promote the health of youth across multiple health domains while also supporting translation and dissemination of the research findings. Strategies may include programs, policies, or practices that seek to improve sexual and reproductive health as well as improve mental and behavioral health in a manner that also addresses health equity among youth in local education agencies and schools serving rural or AI/AN adolescents. Additionally, strategies may also seek to reduce suicidality, substance use and experiences of violence among school-aged adolescents.

NOFO RFA-DP-24-138 was modified on January 30, 2024. The purpose of this modification was to:

• Add language back into the NOFO regarding the Population of Focus that was inadvertently deleted when the previous modification was processed.

NOFO RFA-DP-24-138 was modified on January 12, 2024. The purpose of this modification was to:

• Update the pre-application teleconference call details: The pre-application teleconference call will be conducted as a Zoom Webinar. You may join the webinar by link and/or by telephone.

o The link is https://cdc.zoomgov.com/j/1601547229?pwd=RWtCbkNBd3BsNEc1VzhSYWEz VHFoUT09 o The passcode is Sz%W3*3* o The phone number is +1 669 254 5252 o The webinar ID is 160 154 7229 o The telephone passcode is 96042177

• Update the Scientific/Research Contact email address: please email your inquiries to researchnofo@cdc.gov

Key Dates Publication Date:

To receive notification of any changes to RFA-DP-24-138, return to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notification Emails" link.

An email address is needed for this service.

Letter of Intent Due Date:

02/09/2024 02/09/2024

Application Due Date:

03/11/2024 03/11/2024

On-time submission requires that electronic applications be error-free and made available to CDC for processing from the NIH eRA system on or before the deadline date. Applications must be submitted to and validated successfully by Grants.gov no later than 11:59 PM U.S. Eastern Time.

https://cdc.zoomgov.com/j/1601547229?pwd=RWtCbkNBd3BsNEc1VzhSYWEzVHFoUT09 https://cdc.zoomgov.com/j/1601547229?pwd=RWtCbkNBd3BsNEc1VzhSYWEzVHFoUT09 https://www.grants.gov/

Applicants will use a system or platform to submit their applications through Grants.gov and eRA Commons to CDC. ASSIST, an institutional system to system (S2S) solution, or Grants.gov Workspace are options. ASSIST is a commonly used platform because it provides a validation of all requirements prior to submission and prevents errors.

For more information on accessing or using ASSIST, you can refer to the ASSIST Online Help Site at: https://era.nih.gov/erahelp/assist. Additional support is available from the NIH eRA Service desk via http://grants.nih.gov/support/index.html.

• E-mail: commons@od.nih.gov

• Phone: 301-402-7469 or (toll-free) 1-866-504-9552

• Hours: Monday - Friday, 7 a.m. to 8 p.m. Eastern Time, excluding Federal holidays

Note: HHS/CDC grant submission procedures do not provide a grace period beyond the application due date time to correct any error or warning notices of noncompliance with application instructions that are identified by Grants.gov or eRA systems (i.e., error correction window).

Scientific Merit Review:

05/21/2024 This date is an estimate.

Secondary Review:

06/24/2024 This date is an estimate.

Estimated Start Date:

09/29/2024 Expiration Date:

04/10/2024 Required Application Instructions It is critical that applicants follow the instructions in the How to Apply - Application Guide except where instructed to do otherwise in this NOFO. Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions.

Note:The Research Strategy component of the Research Plan is limited to 12 pages.

Page Limitations: Pages that exceed the page limits described in this NOFO will be removed and not forwarded for peer review, potentially affecting an application's score.

Applications that do not comply with these instructions may be delayed or may not be accepted for review.

Telecommunications for the Hearing Impaired: TTY 1-888-232-6348 http://grants.nih.gov/support/index.html mailto:commons@od.nih.gov https://grants.nih.gov/grants/how-to-apply-application-guide.html

Executive Summary

• Purpose: This Notice of Funding Opportunity (NOFO) supports research to implement and evaluate strategies aligned with CDC’s What Works in Schools (WWIS) approach for successful implementation in local education agencies and schools serving rural or American Indian and/or Alaska Native (AI/AN) adolescents to address students’ health behaviors, experiences, and outcomes, particularly those related to sexual and reproductive health and mental and behavioral health, as well as suicidality, substance use, and experiences of violence. The purpose of the research is to build the evidence base for innovative, school-based or school-linked strategies that promote the health of youth across multiple health domains while also supporting translation and dissemination of the research findings. Strategies may include programs, policies, or practices that seek to improve sexual and reproductive health as well as improve mental and behavioral health in a manner that also addresses health equity among youth in local education agencies and schools serving rural or AI/AN adolescents. Additionally, strategies may also seek to reduce suicidality, substance use and experiences of violence among school-aged adolescents.

• Mechanism of Support: U01-Research Project – Cooperative Agreement.

• Funds Available and Anticipated Number of Awards: The estimated total funding available, including direct and indirect costs, for the entire five (5)-year project period is $5,000,000.00. The number of awards will be two (2). Awards issued under this NOFO are contingent upon availability of funds and a sufficient number of meritorious applications. Because the nature and scope of the proposed research will vary from application to application, it is also anticipated that the size and duration of each award may also vary. The total amount awarded, and the number of awards will depend upon the number, quality, duration and cost of the applications received.

• Budget and Project Period: The estimated total funding (direct and indirect) for the first year (12-month budget period) will be $1,000,000.00 with individual awards of $500,000.00 each for two awards. The estimated total funding (direct and indirect) for the entire project period will be $5,000,000.00. The project period is anticipated to run from 09/29/2024 to 09/28/2029.

• Application Research Strategy Length: Page limits for the Research Strategy are clearly specified in Section IV. “Application and Submission Information” of this announcement.

• Eligible Institutions/Organizations. Institutions/organizations listed in Section III of this announcement are eligible to apply.

• Eligible Project Directors/Principal Investigators (PDs/PIs). Individuals with the skills, knowledge, and resources necessary to carry out the proposed research are invited to work with their institution/organization to develop an application for support.

Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply.

o NOTE: CDC does not make awards to individuals directly.

• Number of PDs/PIs. There will only be one PD/PI for each application.

• Number of Applications. Only one application per institution (normally identified by having a unique UEI number) is allowed. Multiple applications from different divisions of the same institution will be returned without further consideration by CDC.

• Application Type. New

• Application Materials. See Section IV.1 for application materials. Please note that

SF424 (R&R) Form H is to be used when completing the application package. Please see

SPECIAL DATE

A pre-application teleconference call will be conducted on Wednesday, February 7, 2024 to address questions from prospective applicants. The call will begin at 3PM Eastern Time (ET) and will last approximately one (1) hour. Questions and answers from the discussion will be transcribed and published on Grants.gov under NOFO RFA-DP-24-138 approximately 2-3 weeks after the call.

Participant Access Information:

• Date: Wednesday, February 7, 2024

• Time: 3PM Eastern Time (ET)

• Call Leader: Celeste Sanders, PhD, Scientific Program Official

• Link:

https://cdc.zoomgov.com/j/1601547229?pwd=RWtCbkNBd3BsNEc1VzhSYWEzVHFo

UT09

o Passcode: Sz%W3*3*

• Phone Number: +1 669 254 5252 o Webinar ID: 160 154 7229 o Telephone passcode: 96042177

Section I. Funding Opportunity Description Statutory Authority Section 301(a) [42 U.S.C. 241(a)] of the Public Health Service Act, and Section 391(a) [42 U.S.C. 280 b(a)] of the Public Health Service Act, as amended.

1. Background and Purpose The CDC’s Division of Adolescent and School Health (DASH) seeks to ensure all youth in the U.S. are equipped with the knowledge, skills, and resources they need to be healthy as youth and into adulthood. There is a strong focus on reaching youth through schools and an emphasis on addressing social determinants, through a population-based, integrated approach. CDC/DASH is a unique source of support for HIV, sexually transmitted infection (STI), and pregnancy prevention efforts in the nation’s schools, supporting strategies focused on reducing HIV/STIs, and unintended pregnancy along with co-occurring experiences and behaviors such as poor mental health, suicide-related behaviors, substance use, and experiences of violence.

CDC/DASH provides funding and technical assistance that enables local education agencies (i.e., https://grants.nih.gov/grants/how-to-apply-application-guide.html school districts) to deliver HIV/STI and pregnancy prevention programs that are scientifically sound and grounded in the latest research on effectiveness.

Youth Health Behaviors and Experiences

Many young people engage in sexual risk behaviors which can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2021, 30% had ever had sexual intercourse and 21% had sexual intercourse during the previous 3 months (i.e., currently sexually active). Among currently sexually active students, 48% did not use a condom the last time they had sex. (1) Also, 67% did not use effective hormonal birth control the last time they had sex; and 6% of all high school students had had sex with four or more people during their life. (1) Such sexual risk behaviors place adolescents at risk for HIV, STIs, and unintended and mistimed pregnancy. (1)

Sexual risk behaviors often cluster with risk behaviors and experiences across violence, mental health, suicide, and substance use. (2) These co-occurring health risks also share several protective factors, highlighting opportunities to holistically address adolescent health and well-being across multiple health domains. However, not all youth experience the burden of health risks equally, and disparities exist by individual characteristics, like race and ethnicity, as well as by structural contexts, like geography. In particular, social, structural, and historical factors drive and perpetuate disparities in the health and well-being of youth who live in rural areas and AI/AN youth. (3-5) Research using 2017 and 2019 Youth Risk Behavior Survey data found that AI/AN youth are significantly more likely than White youth to experience sadness and hopelessness, consider suicide, attempt suicide, and experience violence at school. (3) Rural areas have higher rates of poverty and less access to healthcare than urban areas, and rural schools are less likely to provide mental health services, all impacting the health and well-being of youth. (4) Considering documented health disparities, continued research on addressing and supporting the health of rural and AI/AN adolescents is needed.

What Works in Schools (WWIS) Approach

To reduce sexual risk behaviors and related health problems among youth, schools and other youth-serving organizations can help young people develop and maintain attitudes and behaviors which promote their health and well-being—including behaviors which reduce risks for HIV/STIs, unintended pregnancy and related health outcomes and experiences. CDC is nearing conclusion of cooperative agreement, PS18-1807: Promoting Adolescent Health through School-based HIV Prevention, with local education agencies (i.e., school districts) and national non-governmental organizations to support efforts to implement the What Works in Schools approach in secondary schools designed to reduce HIV/STI, pregnancy, and related health outcomes among youth. (6)

Components of What Works in Schools (WWIS) Approach

The What Works in Schools (WWIS) approach combines three programmatic strategies:

delivering comprehensive sexual health education, increasing access to youth-friendly health services, and promoting safe and supportive school environments for all youth. (7) Together, these strategies aim to prevent HIV/STI, unintended pregnancy, and related risk behaviors and experiences such as poor mental health, suicide-related behaviors, substance use, and experiences of violence.

https://www.cdc.gov/healthyyouth/about/nofo.htm https://www.cdc.gov/healthyyouth/about/nofo.htm

The WWIS approach includes school-based and school district-wide activities that help strengthen staff capacity, increase student access to programs and services, and engage parents and community partners across all program strategies (i.e., health education, health services, and safe and supportive environments). (7) As part of comprehensive health education, activities focus on implementing instructional programs (i.e., curriculum) which are standards-aligned, culturally responsive and inclusive, and sequential for students in secondary grades. Teachers delivering health education receive professional development to improve their essential knowledge and skills (i.e., instructional competencies) to effectively deliver instruction to all students. The health services strategy includes activities which increase student access to and use of confidential, youth-friendly preventive health services. School districts improve access to health services by implementing activities according to their infrastructure and partnerships which may include referring students to off-site health service providers and providing services on site (e.g., through a school-based health center or wellness clinic). Staff are trained to increase capacity for referring students to on- or off-site health services and integrating skills for accessing health services in comprehensive health education. As part of the safe and supportive environments strategy, activities help foster inclusive school environments where students feel respected by and connected to their peers, teachers, and other adults at school. Activities include implementing Genders and Sexualities Alliance (GSAs) clubs and connecting students to school-or community-based mentoring, service learning, and other positive youth development programming. Professional development for school staff targets effective classroom management and supporting students with lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender identities (LGBTQ+). In addition, activities to increase school, parent, and community engagement are integrated throughout each program strategy. For example, schools and school districts can create and maintain school health advisory councils or teams, inclusive of students, staff, parents, and community members, to make recommendations on school health policies, programs, or practices. (7) More details about the WWIS approach is available at https://www.cdc.gov/healthyyouth/whatworks/index.htm. For a detailed program description and logic model, including short, intermediate, and long-term outcomes see https://www.grants.gov/search-results-detail/351244 (available February 1, 2024) and https://www.cdc.gov/healthyyouth/fundedprograms/index.htm.

Evidence for the WWIS Approach and Current Gaps

Evaluation of previous iterations of the WWIS approach show significant effects in reducing the odds of ever having sex, having four or more lifetime sexual partners, being currently sexually active, missing school due to safety concerns, lifetime experience of forced sex, and lifetime and current use of marijuana among students attending schools that were focused on implementing the WWIS program compared to students in the same districts in schools that were not the focus of implementing the program.(8) Evaluation among a subgroup of lesbian, gay, and bisexual students found reductions in odds of ever having sex and increased odds of condom use among sexually active youth. (9) Additional dose-response analyses found that incremental implementation of activities under the safe and supportive environments strategy was associated with reductions in odds of ever having sex, having four or more lifetime sexual partners, being currently sexually active, using effective hormonal birth control, dual use of condoms and effective hormonal birth control, lifetime experience of forced sex, missing school due to safety concerns, and lifetime and current marijuana use.(10) Analysis of LGBTQ+-supportive school policies and practices recommended in CDC’s WWIS approach also found associations between https://www.cdc.gov/healthyyouth/whatworks/index.htm https://www.grants.gov/search-results-detail/351244 https://www.cdc.gov/healthyyouth/fundedprograms/index.htm implementation of supportive practices and increased odds of ever being tested for HIV and reduction in odds of ever having sex, feeling threatened at school, lifetime experience of forced sex, persistent feelings of sadness and hopelessness, and suicide-related behaviors among both LGB and heterosexual students. (11,12)

To date, this evaluation evidence highlights the potential for schools and school districts to positively impact youth health behaviors and experiences by applying the WWIS approach, yet gaps remain in understanding program implementation, adaptation, and effectiveness for tailored adolescent groups. Specifically, studies are needed to examine the effectiveness of WWIS in schools serving rural adolescents and AI/AN. This NOFO supports studies to implement and evaluate strategies aligned with CDC’s WWIS approach for successful implementation in school districts and schools serving rural or AI/AN adolescents to address health behaviors, experiences, and outcomes, and supports translation and dissemination of the studies' findings.

References

1. Centers for Disease Control and Prevention. Youth Risk Behavior Data Summary and Trends Report. 2023. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data- Summary-Trends_Report2023_508.pdf

2. Bozzini AB, Bauer A, Maruyama J, Simoes R, Matijasevich A. Factors associated with risk behaviors in adolescence: a systematic review. Braz J Psychiatry. Mar-Apr 2021;43(2):210-221. doi:10.1590/1516-4446-2019-0835

3. Jones SE, Satter DE. Implications for Coding Race and Ethnicity for American Indian and Alaska Native High School Students in a National Survey. J Health Care Poor Underserved. 2022;33(3):1245-1257. doi:10.1353/hpu.2022.0110

4. Graves JM, Abshire DA, Mackelprang JL, et al. Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools. Am J Prev Med. Jan 2023;64(1):1-8. doi:10.1016/j.amepre.2022.09.003

5. Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K.., & Valenzuela, C.

(2023). Births: Final Data for 2021. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf

6. Centers for Disease Control and Prevention. PS18-1807 Program Guidance: Guidance for School-based HIV/STD Prevention (Component 2) Recipients of PS18-1807. Atlanta, GA: U.S. Department of Health and Human Services; 2019.

https://www.cdc.gov/healthyyouth/fundedprograms/1807/resources/PS18-1807- GUIDANCE508.pdf

7. Wilkins NJ, Rasberry C, Liddon N, et al. Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being. J Adolesc Health. Apr 2022;70(4):540-549.

doi:10.1016/j.jadohealth.2021.05.017

8. Robin L, Timpe Z, Suarez NA, Li J, Barrios L, Ethier KA. Local Education Agency Impact on School Environments to Reduce Health Risk Behaviors and Experiences Among High School Students. J Adolesc Health. Feb 2022;70(2):313-321.

doi:10.1016/j.jadohealth.2021.08.004

9. Suarez NA, Cooper AC, Kaczkowski W, Li J, Robin L, Sims VM. Associations of a Multilevel School Health Program and Health Outcomes Among Lesbian, Gay, and https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf http://www.hhs.gov/asfr/ogapa/acquisition/effspendpol_memo.html http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/tobacco/index.htm http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/tobacco/index.htm

Bisexual Youth. AIDS Educ Prev. Oct 2022;34(5):395-412.

doi:10.1521/aeap.2022.34.5.395

10. Li J, Timpe Z, Suarez NA, et al. Dosage in Implementation of an Effective School-Based Health Program Impacts Youth Health Risk Behaviors and Experiences. J Adolesc Health. Sep 2022;71(3):334-343. doi:10.1016/j.jadohealth.2022.04.009

11. Kaczkowski W, Cooper AC, Li J, Robin L. The Association of LGBTQ-Supportive School Health Policies and Practices with Sexual Health Outcomes. LGBT Health. Aug- Sep 2022;9(6):384-392. doi:10.1089/lgbt.2021.0132

12. Kaczkowski W, Li J, Cooper AC, Robin L. Examining the Relationship Between LGBTQ-Supportive School Health Policies and Practices and Psychosocial Health Outcomes of Lesbian, Gay, Bisexual, and Heterosexual Students. LGBT Health. Jan 2022;9(1):43-53. doi:10.1089/lgbt.2021.013311

Healthy People 2030 and other National Strategic Priorities This NOFO supports efforts that align with the following public health priorities:

• Healthy People 2030 – o Social Determinants of Health: education; social and community context; health and health care, neighborhood and built environment.

o Health topics: adolescent health; LGBT health; educational and community-based programs; schools; health-related quality of life and well-being; HIV; pregnancy;

sexually transmitted infections; drug and alcohol use; violence prevention; and mental health.

• Ending the HIV Epidemic in the U.S. (EHE) initiative aimed aims to end the HIV epidemic in the United States by 2030. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/

• CDC’s Health Impact in 5 Years (HI-5) initiative includes interventions addressing the social determinants of health, and interventions changing the context.

https://www.cdc.gov/policy/hi5/index.html

• HHS. Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals addresses supports for LGBTQI+ youth in the nation’s schools and educational institutions. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/

• HHS. National Stakeholder Strategy for Achieving Health Equity provides an overarching roadmap for eliminating health disparities through cooperative and strategic actions. https://www.phdmc.org/agency/programs-services/local-office-on-minority-health/64-achieving-health-equity/file

Public Health Impact This NOFO will support (1) evaluation of strategies aligned with CDC’s What Works in Schools (WWIS) approach for successful implementation in local education agencies and schools serving rural or AI/AN adolescents to address health behaviors, experiences, and outcomes, and (2) support translation and dissemination of the studies' findings. Successful implementation may require some adaptation of the current WWIS approach. This work will advance the evidence base and build capacity for education agencies in a variety of settings to implement WWIS.

https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ https://www.cdc.gov/policy/hi5/index.html https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/ https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/ https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/15/executive-order-on-advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals/ http://www.hhs.gov/asfr/ogapa/acquisition/ http://www.hhs.gov/asfr/ogapa/acquisition/

Successful research projects will include consistent and meaningful engagement and collaboration with partners such as local education and public health agencies, schools, youth-serving organizations, healthcare providers, youth, parents, families, and community members.

Expected impacts include prevention and reduction of risk behaviors related to sexual and reproductive health and behavioral and mental health, as well as suicidality, substance use, and experiences of violence.

Health Equity:

CDC supports efforts to improve the health of populations disproportionately affected by infectious diseases by maximizing the health impact of public health services, reducing disease incidence, and advancing health equity. A health disparity occurs when a health outcome is seen to a greater or lesser extent between populations. Health disparities in infectious diseases are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these infections and diseases.

Social determinants are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes (https://www.cdc.gov/socialdeterminants/index.htm). These include conditions for early childhood development, education, employment, and work, food security, health services, housing, income, and social exclusion. Health equity is a desirable goal that entails special efforts to improve the health of those who have experienced social or economic challenges. It requires:

• Continuous efforts focused on elimination of health disparities, including disparities in health and in the living and working conditions that influence health, and

• Continuous efforts to maintain a desired state of equity after health disparities are eliminated.

Applicants should use data, including social determinants data, to identify communities within their jurisdictions that are disproportionately affected by infectious diseases and related diseases and conditions, and plan activities to help eliminate health disparities. In collaboration with partners and appropriate sectors of the community, applicants should consider social determinants of health in the development, implementation, and evaluation of specific efforts and use culturally appropriate interventions and strategies that are tailored for the communities for which they are intended.

Relevant Work CDC/DASH’s current WWIS approach is a model reflected in different iterations over two previous program cooperative agreements, PS13-1308 and PS18-1807.

• CDC-FOA-PS13-1308, Promoting Adolescent Health Through School-Based HIV/STD Prevention and School-Based Surveillance (https://www.cdc.gov/healthyyouth/fundedprograms/1308/pdf/rfa-1308.pdf) o Kaczkowski, W., Cooper, A.C., Li, J., & Robin, L. (2022) The association of LGBTQ-supportive school health policies and practices with sexual health outcomes. LGBT Health; 9(6), 384-392. https://doi.org/10.1089/lgbt.2021.0132 o Kaczkowski, W., Li, J., Cooper, A. C., & Robin, L. (2022). Examining the relationship between LGBTQ-supportive school health policies and practices and https://www.cdc.gov/grants/additional-requirements/ar-8.html https://grants.nih.gov/grants/rppr/rppr_instruction_guide.pdf https://www.hhs.gov/civil-rights/for-individuals/sex-%20discrimination/index.html psychosocial health outcomes of lesbian, gay, bisexual, and heterosexual students.

LGBT Health, 9(1), 43-53. https://doi.org/10.1089/lgbt.2021.0133 o Li, J., Timpe, Z., Suarez, N. A., Phillips, E., Kaczkowski, W., Cooper, A. C., Dittus, P. J., Robin, L., Barrios, L. C., & Ethier, K. A. (2022). Dosage in implementation of an effective school-based health program impacts youth health risk behaviors and experiences. Journal of Adolescent Health, 71(3), 334-343.

https://doi.org/10.1016/j.jadohealth.2022.04.009 o Robin, L., Timpe, Z., Suarez, N. A., Li, J., Barrios, L., & Ethier, K. A. (2022).

Local education agency impact on school environments to reduce health risk behaviors and experiences among high school students. Journal of Adolescent Health, 70(2), 313-321. https://doi.org/10.1016/j.jadohealth.2021.08.004 o Suarez, N. A., Cooper, A. C., Kaczkowski, W., Li, J., Robin, L., & Sims, V. M.

(2022). Associations of a multilevel school health program and health outcomes among lesbian, gay, and bisexual youth. AIDS Education and Prevention, 34(5), 395-412. https://doi.org/10.1521/aeap.2022.34.5.395

• CDC-RFA-PS18-1807, Promoting Adolescent Health through School-Based HIV Prevention (https://www.cdc.gov/healthyyouth/about/nofo.htm) o Centers for Disease Control and Prevention. PS18-1807 program guidance:

Guidance for school-based HIV/STD prevention (Component 2) recipients of PS18-1807. Atlanta, GA: U.S. Department of Health and Human Services; 2019.

https://www.cdc.gov/healthyyouth/fundedprograms/1807/resources/PS18-1807- GUIDANCE508.pdf o Wilkins, N. J., Rasberry, C., Liddon, N., Szucs, L. E., Johns, M., Leonard, S., Goss, S. J., & Oglesby, H. (2022). Addressing HIV/sexually transmitted diseases and pregnancy prevention through schools: an approach for strengthening education, health services, and school environments that promote adolescent sexual health and well-being. Journal of Adolescent Health, 70(4), 540-549.

https://doi.org/10.1016/j.jadohealth.2021.06.017

2. Approach Research studies supported by this NOFO are expected (1) to implement and evaluate strategies aligned with CDC’s What Works in Schools (WWIS) approach for successful implementation in local education agencies and schools serving rural or AI/AN adolescents to address health behaviors, experiences, and outcomes, and (2) to support translation and dissemination of the studies' findings. All research activities should focus on communities who are experiencing high levels of health disparities or health inequities. Applicants are expected to consider the underlying social and structural conditions (e.g., Social Determinants of Health) that contribute to, drive, or perpetuate health disparities or inequities. For more information visit https://www.cdc.gov/chronicdisease/healthequity/health-equity-science.html.

This NOFO will support studies aimed at implementing and evaluating strategies aligned with WWIS approach, including adaptations addressing sexual and reproductive health and mental and behavioral health, in local education agencies and schools serving one of the following populations (Choose only one):

1. Rural adolescents https://www.cdc.gov/grants/additional-requirements/ar-33.html http://www.phe.gov/s3/dualuse http://grants.nih.gov/grants/ElectronicReceipt/avoiding_errors.htm https://www.grants.gov/web/grants/support.html https://www.cdc.gov/healthyyouth/about/nofo.htm https://www.cdc.gov/healthyyouth/fundedprograms/1807/resources/PS18-1807-GUIDANCE508.pdf https://www.cdc.gov/healthyyouth/fundedprograms/1807/resources/PS18-1807-GUIDANCE508.pdf https://doi.org/10.1016/j.jadohealth.2021.06.017 https://www.cdc.gov/chronicdisease/healthequity/health-equity-science.html

2. AI/AN adolescents

Please note: applicants must indicate the chosen population on the Specific Aims page of their application.

Applicants who select to implement and evaluate strategies aligned with the WWIS approach for schools serving rural adolescents are expected to work primarily in school districts and schools not included within an urban area. Additional guidance from HRSA and the Federal Office of Rural Health can be found at: https://www.hrsa.gov/rural-health/about-us/what-is-rural .

Applicants who choose to implement and evaluate strategies aligned with the WWIS approach for schools serving AI/AN adolescents are expected to work with school districts and schools serving a significant population of AI/AN adolescents. These school districts and schools may be located in urban, suburban, rural, and/or tribal communities. Applicants proposing to work with school districts and schools within tribal settings or communities are expected to demonstrate approval and support or a tribal resolution for the proposed project from a currently elected tribal leader(s).

Studies are expected to employ a quasi-experimental design (i.e., use of comparison group(s)) and use implementation science frameworks, theories, principles, and methods. Studies should use equity-based frameworks, measures, and methodologies intended to address the needs of adolescents excluded or marginalized (e.g., youth in rural communities, AI/AN youth, youth in tribal or native communities, youth of color, youth with LGBTQ+ identities) in their design, implementation, and evaluation approach. Studies may also include Indigenous Knowledge methods and approaches. Indigenous Knowledge is a body of observations, oral and written knowledge, innovations, practices, and beliefs developed by Tribes and Indigenous Peoples through interaction and experience with the environment, and related practices”. Strategies may not yet be rigorously evaluated and are considered innovative and community-based, including a variety of activities (e.g., traditional, healing, and spiritual practices such as ceremonies and rituals, talking circles, and drumming; wellness practices such as learning and speaking a traditional language, engaging in traditional practices, and developing connectedness through community and family activities). Studies are strongly encouraged to incorporate voices, perspectives, and input from program recipients (e.g., school staff, students), implementers (e.g., district and school staff), and partners (e.g., community organizations or healthcare providers) about contexts, priorities, and needs when determining necessary adaptations to evaluate WWIS-aligned strategies.

Studies may use a combination of existing data and newly collected data to answer select research questions, including various methods (e.g., surveys, focus groups, interviews, classroom observations) to gather information from program recipients (e.g., school staff, students), implementers (e.g., district and school staff), and partners (e.g., community organizations or healthcare providers). Applications should include a plan to get approval for any research with human subjects through their affiliated Institutional Review Board for the Protection of Human Subjects. Studies should include reaching students within one or more school districts in sufficient numbers to provide statistical power for measuring changes in student health behaviors and experiences as a result of the implemented approach strategies. A detailed list of student-level health behaviors and experiences of interest is included in the table below and aligns with CDC’s priority health domains.

https://www.hrsa.gov/rural-health/about-us/what-is-rural

Applicants should include plans to provide technical assistance to their partnering local education agencies (i.e., school districts) to support implementation of strategies aligned with CDC’s WWIS approach in each project. Applications should specify how to translate project findings and develop tools and resources to guide and support WWIS-related technical assistance for education agencies and other youth-serving organizations working to address the health of youth in equitable and sustainable ways. Lastly, an annual budget allocation for financial support to the partnering local education agencies is recommended. This financial support is to help local education agencies address challenges or barriers limiting their participation in this NOFO, including but not limited to staffing limitations and budget constraints.

Student health outcomes of interest aligned with CDC’s What Works in Schools (WWIS) priority domains and protective factors

Priority Domain Student health behaviors and experiences of interest

Sexual and reproductive health

• Ever had sexual intercourse

• Number of sexual partners

• Currently sexually active

• Condom use at last sexual intercourse

• Effective hormonal contraceptive use

• Condom and effective hormonal contraceptive use (dual method use)

• STI testing

• HIV testing

Behavioral and mental health, including suicide-related behaviors

• Persistent feelings of sadness or hopelessness

• Poor mental health

• Seriously considering attempting suicide

• Made a suicide plan

• Attempted suicide

• Injured in a suicide attempt

Substance use

• Alcohol use

• Marijuana use

• Electronic vapor product use

• Use of select illicit drugs

• Prescription opioids misuse

Violence

• Threatened or injured with a weapon at school

• Not attending school due to safety concerns

• Electronically bullied

• Bullied at school

• Forced to have sex

• Experienced sexual or dating violence

Protective Factors

• School connectedness

• Parental monitoring

a. What adaptations to the current CDC WWIS approach are needed to implement WWIS with schools serving rural or AI/AN adolescents?

Applications should describe a plan to address the following high-level evaluation questions about strategies aligned with the WWIS approach in schools serving rural and AI/AN adolescents:

a. To what extent does CDC’s WWIS approach affect students’ health behaviors, experiences, and outcomes in schools serving rural and AI/AN adolescents?

b. To what extent does CDC’s WWIS approach affect staff’s (including staff in schools, community-based organizations, and community healthcare providers) capacity and experiences with program implementation in schools serving rural or AI/AN adolescents?

c. What barriers and facilitators exist when implementing CDC’s WWIS approach with schools serving rural or AI/AN adolescents?

d. How can CDC’s WWIS approach be implemented more equitably (e.g., in settings where financial and human resources are low, or where cultural or social norms affect health behaviors)?

e. How can evidence-based strategies aligned with CDC’s WWIS approach under investigation be scaled up to broader regions or populations?

f. What research supports/activities are necessary for successful implementation? Are they replicable?

Applications should describe plans to accomplish the following activities:

Activity 1. Engage partners to build capacity for program adaptation and implementation of WWIS-aligned strategies.

1. Build and maintain relationships with one or more school districts, their schools, and relevant partners to support implementation and evaluation of the WWIS-aligned strategies.

2. Communicate information about research project activities to intended audiences and partners using a variety of channels.

Activity 2. Collaborate with partners to design and conduct evaluation research that aligns with one of the identified research priorities for this NOFO.

1. Identify a project timeline that includes all research activities to be achieved during the 5-year period of performance for this NOFO. The timeline should include but is not limited to (1) school/school district recruitment, research protocol and instrument development, implementation, data collection and analysis, (2) dissemination of research project findings, tools, and lessons learned to community, public health and education practitioners, and academic audiences, and (3) translation of research findings and lessons learned. The timeline should be updated at least semi-annually to note any modifications to the plan.

2. Engage partnering school districts, schools, and relevant partners in all aspects of the research process including designing and conducting the project, implementing WWIS-aligned strategies, managing and analyzing data, and disseminating findings. These include but are not limited to partners that can: (a) support implementation, (b) deliver the intervention and (c) translate research findings for sustainability and scale-up beyond the project period.

3. Apply equity-based frameworks, measures, and methods intended to address the needs of adolescents excluded or marginalized (e.g., youth in rural settings, AI/AN youth, youth of color, youth with LGBTQ+ identities) in all aspects of the research process.

4. Secure all research approvals, including human subjects research determination, and if needed, Paperwork Reduction Act approval from the Office of Management and Budget

(OMB).

5. Develop an evaluation report that includes how and why WWIS-aligned strategies were adapted, barriers and facilitators to implementation, and data documenting effectiveness of strategies and changes in outcomes of interest.

Activity 3. Develop and disseminate research findings and products.

1. Develop and annually update a plan to disseminate research findings and key implementation support materials for use by project partners and the public.

Dissemination activities should include publishing and presenting project findings through peer-reviewed channels (e.g., journal articles, conference/meeting presentations).

Activities should reach a diverse range of audiences using a variety of strategies and channels.

2. Annually, implement activities to disseminate key implementation support materials and research findings.

o Any products and materials created under a cooperative agreement from this NOFO must be available and accessible at no additional expense to CDC and the research partners.

Activity 4. Conduct activities to support translation of research findings to improve practice of WWIS-aligned strategies.

1. Develop and annually update a plan to translate research findings and key implementation support materials for use by project partners and the public.

Considerations for using implementation science and research translation frameworks (e.g., Knowledge into Action Framework) should be made when developing and implementing the Translation Plan. The plan should also identify appropriate audiences, strategies, and communication channels to translate project findings. Translation products may include summaries of key findings and data visualization for project partners, as well as lessons learned and success stories to be shared with the broader public.

2. Implement the translation plan.

Activity 5. Routinely communicate with selected research partners, organizations, agencies and the CDC on an ongoing basis.

1. Attend at least one (1) meeting in Atlanta within the first six (6) months of the cooperative agreement to discuss research project and plan for all activities for the year.

2. Communicate with partner agencies/organizations participating in the research project and the CDC on the progress of project activities and implementation through phone, e-mail, and other methods of communication on a regular basis.

Objectives/Outcomes Short-Term Outcomes (STO):

• STO1. Increase program implementation and evaluation data collection/compilation among NOFO partners (e.g., collaborating local education agencies and schools).

• STO2. Increase understanding of strategies aligned with CDC’s WWIS approach among NOFO partners.

Intermediate-Term Outcomes (IO):

• IO1. Increase implementation and adoption of evidence-based school strategies aligned with CDC’s WWIS approach.

• IO2. Expand the evidence base on the effectiveness of strategies aligned with CDC’s WWIS approach.

• IO3. Increase student or staff receipt of or exposure to strategies aligned to CDC’s WWIS.

Long-Term Outcomes (LTO):

• LTO1. Reduce disparities in health behaviors, outcomes, and experiences among youth in schools serving rural and AI/AN adolescents.

• LTO2. Improve health outcomes among youth, specifically to include, but not be limited to:

▪ Decreased sexual risk behavior

▪ Improved mental health

▪ Decreased violence-related behaviors and experiences

▪ Decreased substance use

▪ Increased protective behaviors and factors

Population of Focus This NOFO has a specific focus on reaching rural or AI/AN adolescents. This NOFO addresses the public health needs of the rural or AI/AN adolescents in population groups that exhibit disproportionately high prevalence of health risk behaviors and experiences which are amenable to prevention intervention, such as the following populations and communities:

• Populations experiencing health disparities due to race, ethnicity, gender identity or expression, sexual orientation, rural geography, tribal affiliation or community attachment, socioeconomic status, disability status, primary language, health literacy, and other relevant dimensions.

• Communities disadvantaged by social and structural determinants of health that create health inequities.

In the Research Plan, applicants should clearly identify the population and communities they will address and describe the health disparities and health inequities they experience and how the proposed research can benefit the identified population of focus and communities. Furthermore, as outlined in the objectives of this NOFO, the applicant should clearly identify whether they will be working with local education agencies serving rural or serving AI/AN adolescents.

Collaboration/Partnerships It is anticipated that research supported under this NOFO will involve collaboration with both CDC and external partners (e.g., education and public health agencies, youth-serving organizations, healthcare providers, individuals, community members, governmental, non-governmental and private sector partners) on projects for the purpose of implementing and evaluating strategies aligned with CDC’s What Works in Schools (WWIS) approach for successful implementation in local education agencies and schools serving rural or AI/AN adolescents to address students’ health behaviors, experiences, and outcomes, and supporting translation and dissemination of the studies' findings. At a minimum, applicants will be expected to show evidence of their ability to work with one or more school districts to conduct the proposed research projects. The research plan should include reaching students within one or more districts in sufficient numbers to provide statistical power for measuring changes in student health behaviors and experiences as a result of the implemented program strategies.

It is also expected that collaboration among recipient staff and external partners on research will result in shared decision-making, resource sharing, and the creation of key implementation support materials and translation products. School and community engagement is fundamental to both the success and relevance of the research and activities supported by this cooperative agreement.

Evaluation/Performance Measurement The application should include measurable goals and aims based on the full 5-year research project period. The application should describe specific, measurable, achievable, realistic and time-phased (SMART) project objectives for each activity described in the application’s project plan and describe the development and implementation of project performance measures based on specific programmatic objectives.

Applicants can use evaluation findings to ensure continuous program quality improvement, help create an evidence base for strategies aligned with CDC’s WWIS approach and assess which…