PKG00248921-instructions.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

Good Health and Wellness in Indian Country

CDC-RFA-DP19-1903

Application Due Date: 05/15/2019

Good Health and Wellness in Indian Country

CDC-RFA-DP19-1903

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text 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 Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DP19-1903. 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:

Good Health and Wellness in Indian Country 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 this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP19-1903

E. Assistance Listings (CFDA) Number:

93.479 F. Dates:

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

2. Due Date for Applications: 05/15/2019, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

Tuesday, March 19, 2019 from 3:00 p.m. - 4:30 p.m., EDT. Call 1-800-857-9824. Participant Passcode: 4720690

To submit a question related to this NOFO, please email your question to GHWIC_requests @cdc.gov. Responses will be posted at https://www.cdc.gov/chronicdisease/about/foa/ghwic /index.htm in Frequently Asked Questions (FAQs).

G. Executive Summary:

1. Summary Paragraph:

The Centers for Disease Control and Prevention (CDC) announces the availability of Fiscal Year (FY) 2019 funds to implement CDC-RFA-DP19-1903, Good Health and Wellness in Indian Country (GHWIC).

The purpose of this NOFO is to reduce rates of death and disability from commercial tobacco use, diabetes, heart disease and stroke, and reduce the prevalence of obesity and other chronic 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.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov mailto:GHWIC_requests@cdc.gov mailto:GHWIC_requests@cdc.gov https://www.cdc.gov/chronicdisease/about/foa/ghwic/index.htm https://www.cdc.gov/chronicdisease/about/foa/ghwic/index.htm disease risk factors and conditions (e.g., oral health, dementia, COPD). This NOFO has three

(3) separate, competitive components with eligibility and scope of work requirements for each.

Applicants must submit a separate application for each component for which they are applying.

The NOFO is based on the best available evidence for policy, systems, and environmental changes, and clinical-community linkage strategies, which may be culturally adapted to meet the needs of American Indian and Alaska Native communities.

The long-term outcomes of this NOFO are:

Increased purchasing of healthy foods.

Increased physical activity with an emphasis on walking.

Increased breastfeeding.

Reduced prevalence of commercial tobacco use.

Reduced incidence of type 2 diabetes.

Reduced prevalence of high blood pressure.

Reduced prevalence of high blood cholesterol.

This is a five-year funding opportunity (five-year period of performance, one-year budget period).

For frequently asked questions (FAQs), go to https://www.cdc.gov/chronicdisease/about/foa /ghwic/index.htm. To submit an FAQ, send an email to GHWIC_requests@cdc.gov.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 30 Component 1: Federally-recognized Tribes and Alaska Native Villages (12) and Urban Indian Organizations (4) Component 2: Tribally-designated Organizations (13), up to 1 in each Area (the 12 IHS Administrative Areas) and the Urban Area defined as the Urban Indian Organizations.

Component 3: Tribally-designated Organization (1)

d. Total Period of Performance Funding: $100,000,000

e. Average One Year Award Amount: $725,000 Component 1: $325,000 (range $100,000 - $375,000) Component 2: $1,050,000 (range $750,000- $1,450,000) Component 3: $800,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 09/30/2019

h. Cost Sharing and / or Matching Requirements: N 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.

https://www.cdc.gov/chronicdisease/about/foa/ghwic/index.htm https://www.cdc.gov/chronicdisease/about/foa/ghwic/index.htm mailto:GHWIC_requests@cdc.gov https://www.ihs.gov/locations/ https://www.ihs.gov/locations/ https://www.ihs.gov/urban/nationalprograms/

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview American Indians and Alaska Natives (AI/AN) have higher rates of disease, injury, and premature death than other racial and ethnic groups [1, 2]. AI/AN adults have a higher prevalence of obesity and commercial tobacco use, and double the prevalence of diagnosed diabetes [3].

Deaths from stroke and heart disease are also higher [4]. Since 2014, NCCDPHP has funded three

(3) cooperative agreements to reduce health disparities and increase health equity among AI/AN.

Good Health and Wellness in Indian Country (DP14-1421, or GHWIC), launched in September 2014 and concluding September 2019, has the long-term goals of reducing rates of death and disability from tobacco use, diabetes, heart disease and stroke, and reducing obesity. GHWIC supported a holistic approach to healthy living and chronic disease prevention. GHWIC's Component 1 recipient activities addressed NCCDPHP's four domains: epidemiology and surveillance, environmental approaches, health system interventions, and community clinical linkages [6]. Component 2 recipients provided technical assistance and subawards to Area Tribes, increasing the reach of GHWIC funding to nearly 120 tribes.

Tribal Epi Center Public Health Infrastructure (DP17-1704, or TECPHI), launched in October 2017, to reduce chronic disease and risk factors, reduce disparities in health outcomes, and improve overall health by building public health capacity and infrastructure in Indian Country for disease surveillance, epidemiology, prevention and control of disease, injury or disability, and program monitoring and evaluation [7].

In May 2018, CDC launched Tribal Practices for Wellness in Indian Country (DP18- 1812, or Tribal Practices). This 3-year funding opportunity supports traditional tribal practices that build resiliency and connections to community, family, and culture, which over time, can reduce risk factors for chronic disease among AI and AN [8].

This NOFO will build on the successes and lessons of GHWIC, TECPHI and Tribal Practices.

1. Arias, E., J. Xu, and M.A. Jim, Period life tables for the non-Hispanic American Indian and Alaska Native population, 2007-2009. Am J Public Health, 2014. 104 Suppl 3: p.

S312-9.

2. Espey, D.K., et al., Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives. Am J Public Health, 2014.

3. Cobb, N., D. Espey, and J. King, Health Behaviors and Risk Factors Among American Indians and Alaska Natives, 2000-2010. Am J Public Health, 2014.

4. Veazie, M., et al., Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009. Am J Public Health, 2014. 104 Suppl 3: p. S359-67.

5. Braun, P.A., et al., A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children. J Dent Res, 2016. 95(11): p.

1237-44.

6. Good Health and Wellness in Indian Country. 2015; Available from: https://www.cdc.gov

/chronicdisease/tribal/factsheet.htm.

7. Tribal Epidemiology Center Public Health Infrastructure. 2017; Available from: https

://www.cdc.gov/chronicdisease/tribal/tecphi.htm.

8. Tribal Practices for Wellness in Indian Country. 2017; Available from: https://www.cdc

.gov/chronicdisease/tribal/tribalpractices.htm.

b. Statutory Authorities This program is authorized under Sections 301(a) and 317 of the Public Health Service Act, 42 U.S.C. Section 241(a) and 247b.

c. Healthy People 2020 Heart Disease and Stroke, Nutrition and Weight Status, Oral Health, Tobacco Use, Physical Activity, Diabetes, Adolescent Health, Early and Middle Childhood, Maternal Infant and Child Health, Social Determinants of Health, and Public Health Infrastructure.

d. Other National Public Health Priorities and Strategies

IHS Special Diabetes Program for Indians:

https://www.ihs.gov/sdp/

IHS Health Promotion Disease Prevention:

https://www.ihs.gov/hpdp

Public Health Accreditation Board (PHAB) Standards and Measures:

https://www.phaboard.org/standards-and-measures-for-initial-accreditation/

The Surgeon General's Call to Action to Support Breastfeeding:

https://www.surgeongeneral.gov/library/calls/breastfeeding/index.html

Step it Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities:

https://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/index .html

Physical Activity Guidelines for Americans, 2nd Edition:

https://health.gov/paguidelines/second-edition/

Dietary Guidelines for Americans 2015-2020:

https://health.gov/dietaryguidelines/2015/

Feeding Ourselves: Food Access, health disparities, and the pathways to healthy Native American communities:

http://www.heart.org/HEARTORG/Advocate/VoicesforHealthyKids/Feeding-Ourselves_ UCM_475570_Article.jsp#

School Health Guidelines to Promote Healthy Eating and Physical Activity:

http://www.cdc.gov/mmwr/pdf/rr/rr6005.pdf

The National Tribal Behavioral Health Agenda:

https://store.samhsa.gov/product/The-National-Tribal-Behavioral-Health-Agenda/PEP16-

NTBH-AGENDA

https://www.cdc.gov/chronicdisease/tribal/factsheet.htm https://www.cdc.gov/chronicdisease/tribal/factsheet.htm https://www.cdc.gov/chronicdisease/tribal/tecphi.htm https://www.cdc.gov/chronicdisease/tribal/tecphi.htm https://www.cdc.gov/chronicdisease/tribal/tribalpractices.htm https://www.cdc.gov/chronicdisease/tribal/tribalpractices.htm https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health https://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health https://www.healthypeople.gov/2020/topics-objectives/topic/public-health-infrastructure https://www.ihs.gov/sdp/ https://www.ihs.gov/hpdp https://www.phaboard.org/standards-and-measures-for-initial-accreditation/ https://www.surgeongeneral.gov/library/calls/breastfeeding/index.html https://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/index.html https://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/index.html https://health.gov/paguidelines/second-edition/ https://health.gov/dietaryguidelines/2015/%20 https://foa.grantsolutions.gov/%20?http:/www.heart.org/HEARTORG/Advocate/VoicesforHealthyKids/Feeding-Ourselves_UCM_475570_Article.jsp https://foa.grantsolutions.gov/%20?http:/www.heart.org/HEARTORG/Advocate/VoicesforHealthyKids/Feeding-Ourselves_UCM_475570_Article.jsp http://www.cdc.gov/mmwr/pdf/rr/rr6005.pdf https://store.samhsa.gov/product/The-National-Tribal-Behavioral-Health-Agenda/PEP16-NTBH-AGENDA https://store.samhsa.gov/product/The-National-Tribal-Behavioral-Health-Agenda/PEP16-NTBH-AGENDA

National Partnership for Action to End Health Disparities:

https://minorityhealth.hhs.gov/npa/

CDC-led National Diabetes Prevention Program:

https://www.cdc.gov/diabetes/prevention/index.htm

2014 Surgeon General's Report: The Health Consequences of Smoking - 50 Years of Progress:

https://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progr ess-by-section.htm

Oral Health in America: A Report of the Surgeon General:

https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBJT/

A Million Hearts Initiative:

https://millionhearts.hhs.gov/index.html

NCCOR - National Collaborative on Childhood Obesity Research:

https://www.nccor.org/

e. Relevant Work These CDC programs have laid important groundwork in chronic disease prevention efforts in Indian Country:

(2002-2004) Honoring Our Health (2005-2008) Identifying Indicators of Environmental Adaptations to Address Diabetes in

AI/AN Communities (2002-2010) Diabetes Education K-12 curriculum, Health is Life in Balance (2008-2014) Using Traditional Foods and Sustainable Ecological Approaches to Promote

Health and Prevent Diabetes in American Indian and Alaska Native Communities (2011-2013) Case studies from 8 tribal communities using Eagle Books (2013-2018) Tribal Public Health Capacity Building and Quality Improvement (2014-2019) A Comprehensive Approach to Good Health and Wellness in Indian Country (2017-2022) Cancer Prevention and Control Programs for State, Territorial, and Tribal

Organizations (2017-2022) Building Public Health Infrastructure in Tribal Communities to Accelerate

Disease Prevention and Health Promotion in Indian Country (2018-2021) Tribal Practices for Wellness in Indian Country (2018-2023) Networking2Save: CDC's National Network Approach to Preventing and

Controlling Tobacco-related Cancers in Special Populations (2018-2023) Tribal Public Health Capacity Building and Quality Improvement Umbrella

Cooperative Agreement and Supplement (2018-2023) Racial and Ethnic Approaches to Community Health (REACH) (2018-2023) Diabetes and Heart Disease & Stroke Prevent Programs-Improving the

Health of Americans through Prevention and Management of Diabetes and Heart Disease and Stroke

(2018-2023) Diabetes and Heart Disease & Stroke Prevent Programs-Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke https://minorityhealth.hhs.gov/npa/ https://www.cdc.gov/diabetes/prevention/index.htm https://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progress-by-section.htm https://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progress-by-section.htm https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBJT/ https://millionhearts.hhs.gov/index.html https://www.nccor.org/

(2018-2023) High Obesity Program (2018-2023) State Physical Activity and Nutrition Program (2018-2023) Improving Student Health and Academic Achievement through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

This NOFO is the collaborative effort of six (6) divisions/office within CDC's National Center for Chronic Disease Prevention and Health Promotion.

Division of Diabetes Translation Division for Heart Disease and Stroke Prevention Division of Nutrition, Physical Activity, and Obesity Division of Oral Health Division of Population Health Office on Smoking and Health

The strategies, activities, and outcomes of this NOFO will build upon the national efforts of these divisions/office to increase the health impact throughout Indian Country. The NOFO combines evidence-informed (1) policy, systems, and environmental change (obesity, tobacco), and (2) clinical-community linkage (diabetes, heart disease and stroke prevention) strategies and activities. The strategies and activities of this NOFO may be culturally-adapted as appropriate to meet the cultural and health needs of American Indian and Alaska Native communities.

This NOFO has three (3) separate, competitive components with eligibility and scope of work requirements for each. Applicants must submit a separate application for each component for which they are applying.

Component 1 (C1) applicants must propose at least one activity from the policy, system, and environmental change (PSE) strategies (obesity or tobacco), one activity from the diabetes prevention community-clinical linkage (CCL) strategies, and one activity from the heart disease and stroke prevention community-clinical linkage strategies in their work plans (for a total of at least three activities). Applicants should describe their plans to implement evidence-informed and culturally-adapted strategies to improve the health of their community members and to prevent chronic diseases and their risk factors. PSE strategies are to prevent obesity and prevent and control commercial tobacco use and exposure. CCL strategies are to prevent type 2 diabetes and prevent heart disease and stroke. Applicants are limited to federally-recognized Tribes, Alaska Native Villages, and Urban Indian Organizations (UIOs) (see Section C, Eligibility Information).

Component 2 (C2) applicants must propose allocating 50% of their annual award in subawards to at least four (4) American Indian Tribes/Alaska Native Villages or Urban Indian Organizations (UIOs), and providing training, technical assistance, and evaluation support to all Tribes/Villages/UIOs in their Area with remaining award funds. C2 applicants must describe how they will make subawards, including the rationale for their approach, so that all four Component

1 strategies (1. Obesity, 2. Commercial tobacco use, 3. Type 2 diabetes, and 4. Heart disease and stroke prevention) are addressed over the 5-year period of performance. This is to ensure these resources and programs reach additional local Tribes/Villages/UIOs beyond those directly funded C1 recipients. Each subawardee must address at least one C1 strategy, yet does not need to address all four strategies; however, all four strategies must be addressed across the group of subawardees over the 5-year period. Applicants do not need to identify the subawardees in the application, but should describe how subawardees will be selected. Applicants must provide subawards and support to at least four (4) Area Tribes/Villages or UIOs and provide technical assistance and services to all Tribes/Villages/UIOs in their Area. Applicants are limited to American Indian or Alaska Native Tribally-designated Organizations that provide services to at least 4 Area Tribes/Villages/UIOs (see Section C, Eligibility Information).

Component 3 (C3) applicants must propose the establishment of a Tribal Coordinating Center (TCC). Applicants should describe how the TCC will be developed and plans to 1) Develop a national communication plan, 2) Coordinate the development and implementation of a national evaluation plan in collaboration with CDC evaluators, and 3) Establish and support a Community of Practice (CoP) consisting of representatives from each C1 and C2 recipient, and facilitate regular CoP meetings to support shared learning and peer support to advance the goals of GHWIC and support prevention of other chronic disease risk factors and conditions (e.g., oral health, dementia, COPD). Applicants are limited to American Indian or Alaska Native Tribally-designated Organizations that provide services to at least 4 Area Tribes/Villages/UIOs (see Section C, Eligibility Information). C3 applicants may also be applicants for C2 funding.

Logic Models: Good Health and Wellness in Indian Country Component 1 Logic Model Bold Intermediate-term Outcomes indicates period of performance outcomes.

Strategy 1: Implement evidenced-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent obesity.

Activities Short-term

Outcomes (1-3 years) Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Improve tribal food and beverage programs/systems (e.g., community gardens, farmers markets, public transportation routes to food stores, access to healthy foods at community venues or schools, using food service guidelines and nutrition standards).

Increased number of places offering healthy foods (e.g., fresh produce, low sodium options) and beverages as a result of improvements to the food system.

Increased number of places offering healthy foods (e.g., fresh produce, low sodium options) and beverages.

Increased percent improvement in number of places offering healthy foods (e.g., fresh produce, low

Increased purchasing of healthier foods.

sodium options) and beverages.

Collaborate with partners to improve land use design to connect activity-friendly routes (e.g., sidewalks, bicycle routes, public transit) with everyday destinations (e.g., homes, schools, work sites, parks).

Increased number of places where community design has been improved to connect places for physical activity in a safe and accessible manner.

Increased number of people using safe and accessible places for physical activity.

Increased percent improvement in number of people using safe and accessible places for physical activity.

Increased physical activity with an emphasis on walking.

Increase continuity of care/community support for breastfeeding by incorporating services into existing community support services (e.g., early care and education centers, community health centers, home visiting programs); establishin g culturally-appropriate and accessible lactation support services (e.g., support groups, walk-in clinics, Baby Cafés); and providing breast feeding support training to health care providers, community health workers, peer support providers, etc.

that work with mothers and babies.

Increased number of places that implement culturally-adapted continuity of care/community support strategies to promote and support breastfeeding.

Increased number of breastfeeding mothers who use community services that support breastfeeding.

Increased percent improvement in number of breastfeeding mothers who use community services that support breastfeeding.

Increased breastfeeding.

Strategy 2: Implement evidenced-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent and control commercial tobacco use.

Activities Short-term

Outcomes (1-3 years) Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Implement commercial tobacco-free policies within workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings.

Increased number of practices and policies addressing protection from secondhand commercial tobacco smoke.

Increased number of workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings that implement commercial tobacco-free policies.

Increased percent improvement in number of workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings that implement commercial tobacco-free policies.

Reduced prevalence of commercial tobacco use.

Provide referrals to evidence-based commercial tobacco cessation treatment, including counseling and FDA-approved medications.

Increased number of referrals to evidence-based commercial tobacco cessation.

Increased number of commercial tobacco-using patients who receive commercial tobacco cessation interventions.

Increased percent improvement in number of commercial tobacco-using patients who

Reduced prevalence of commercial tobacco use.

receive commercial tobacco cessation interventions.

Strategy 3: Implement evidence-informed and culturally-adapted community-clinical linkages (CCL) to support type 2 diabetes prevention.

Activities Short-term Outcomes (1-3 years)

Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Expand access to the National Diabetes Prevention Program (National DPP) lifestyle change program in tribal communities by:

Increasing awareness of prediabetes among tribal members and health care providers/ health professionals (e.g., community wide events, educational campaigns, health-care provider/health professionals training);

Increased number of community members/health professionals educated about prediabetes and associated risk for type 2 diabetes, heart attack, and stroke.

Increased number of community members at high risk for diabetes enrolled in CDC-recognized type 2 diabetes prevention programs offered in AI/AN communities.

Reduced incidence of type 2 diabetes.

Supporting prediabetes screening, testing, and referrals to CDC-recognized type 2 diabetes prevention programs by health care teams, community partners, health para-professionals;

Increased number of adult community members screened and tested for prediabetes and referred to a CDC-recognized type 2 diabetes prevention program if applicable.

Increased number of community members at high risk for diabetes enrolled in CDC-recognized type 2 diabetes prevention programs offered in AI/AN communities.

Reduced incidence of type 2 diabetes.

Establishing or expanding the reach of CDC-recognized type 2 diabetes prevention programs in AI/AN communities and promoting

Increased number of CDC-recognized type 2 diabetes prevention programs/classes offered in AI/AN communities to prevent or delay

Increased number of community members at high risk for diabetes enrolled in CDC-recognized type 2 diabetes prevention

Reduced incidence of type 2 diabetes.

sustainability (e.g., assess exiting resources, CDC-recognized programs offered by other organizations in the AI/AN community, and modes of program delivery options);

onset of type 2 diabetes.

programs offered in AI/AN communities.

Developing culturally-relevant approaches to increase program participation and retention among AI/AN members (e.g., culturally-relevant materials, innovative retention strategies, community members trained as lifestyle coaches).

Increased number of CDC-recognized diabetes prevention programs/classes offering culturally-relevant materials and approaches to increase program participation and retention.

Increased number of community members at high risk for diabetes enrolled in CDC-recognized type 2 diabetes prevention programs offered in AI/AN communities.

Reduced incidence of type 2 diabetes.

Strategy 4: Implement evidence-informed and culturally-adapted community-clinical linkages (CCL) to support heart disease and stroke prevention.

Activities Short-term Outcomes (1-3 years)

Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Expand engagement of community health representatives and other health paraprofessionals to become effective members of chronic disease prevention/ management teams within their local health care systems to manage and refer community members with or at high risk of high blood pressure or high blood cholesterol to appropriate and

Increased number of trained community health representatives who are equipped to deliver evidence-informed, locally available community health programs to support prevention, detection, and control of high blood pressure and/or high blood cholesterol.

Increased percentage of patients 18-85 years of age with diagnosed hypertension who have a BP less than 140/90.

Increased percentage of patients with total cholesterol at goal (LDL and HDL).

Increased number of patients with high blood pressure or high blood cholesterol engaged

Reduced prevalence of high blood pressure.

high blood cholesterol.

locally available health and preventive care programs.

in self-management and treatment programs.

Increased percent improvement in number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Implement team-based care, including non-physician team members (e.g., nurses, pharmacists, patient navigators), in managing patients with or at risk for high blood pressure and/or high blood cholesterol.

Increased number of patients with or at risk for high blood pressure and/or high blood cholesterol receiving team-based care.

Increased percentage of patients 18-85 years of age with diagnosed hypertension who have a BP less than 140/90.

Increased percentage of patients with total cholesterol at goal (LDL and HDL).

Increased number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Increased percent improvement in number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment

Reduced prevalence of high blood pressure.

programs.

Develop culturally-relevant materials and approaches to link tribal/village resources and clinical services to support prevention, detection, and control of high blood pressure and/or high blood cholesterol.

Increased number of culturally-relevant materials and approaches to link tribal/village resources and clinical services to support prevention, detection, and control of high blood pressure and/or high blood cholesterol.

Increased percentage of patients 18-85 years of age with diagnosed hypertension who have a BP less than 140/90.

Increased percentage of patients with total cholesterol at goal (LDL and HDL).

Increased number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Increased percent improvement in number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Reduced prevalence of high blood pressure.

Component 2 Logic Model Bold Intermediate-term Outcomes indicates period of performance outcomes.

Note: Component 2 Recipients will be required to provide the name, funding amount, C1 activities conducted, and progress on C1 outcomes by each Tribe/Village/UIO subawardee funded through this NOFO.

Strategy: Provide funding, training, technical assistance, and evaluation support to Area Tribes/Villages or UIOs conducting activities across all four C1 strategies.

Activities Short-term Outcomes

(1-3 years) Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Expand the implementation of Component 1 strategies and activities to reach at least 4 additional Area Tribes/Villages or UIOs.

Increased number of Area Tribes/Villages/UIOs implementing activities across all four C1 strategies (PSEs and CCLs).

Increased number of Area Tribes/Villages/UIOs implementing activities across all four C1 strategies (PSEs and CCLs).

Increased purchasing of healthy foods.

Increased physical activity with an emphasis on walking.

Reduced prevalence of commercial tobacco use.

Reduced incidence of type 2 diabetes.

Reduced prevalence of high blood pressure.

Reduced prevalence of high blood cholesterol.

Provide technical assistance, training, and resources to all Area Tribes/Villages/UIOs to support the planning, development, implementation, and evaluation of activities across all four C1 strategies.

Increased number of Area Tribes/Villages/UIOs implementing activities across all four C1 strategies (PSEs and CCLs).

Increased number of Area Tribes/Villages/UIOs implementing activities across all four C1 strategies (PSEs and CCLs).

Increased purchasing of healthy foods.

Increased physical activity with an emphasis on walking.

Reduced prevalence of commercial tobacco use.

Reduced incidence of type 2 diabetes.

Reduced prevalence of high blood pressure.

Reduced prevalence of high blood cholesterol.

Assist Area Tribes/Villages/UIOs in developing multi-sector partnerships with organizations to support

Increased number of Area Tribes/Villages/UIOs engaged in active collaborations with

Increased number of Area Tribes/Villages/UIOs implementing activities across all

Increased purchasing of healthier foods.

Increased physical activity with an

C1 strategies and activities in Tribes/Villages/UIOs.

health sector partners and non-health sector partners to support activities across all four C1 strategies.

emphasis on walking.

commercial tobacco use.

Reduced incidence of type 2 diabetes.

Reduced prevalence of high blood pressure.

Reduced prevalence of high blood cholesterol.

Work with Area Tribes/Villages/UIOs to develop and implement tailored health communication/ messaging strategies to reach AI/AN populations at greatest risk for obesity, commercial tobacco use, type 2 diabetes, and/or heart disease and stroke in order to increase awareness and encourage healthier behaviors.

Increased number of communication messages disseminated by Area Tribes/Villages/UIOs to reach AI/AN populations at greatest risk for obesity, commercial tobacco use, type 2 diabetes, and/or heart disease and stroke in order to increase awareness and encourage appropriate health behaviors.

Increased number of Area Tribes/Villages/UIOs implementing activities across all

Increased purchasing of healthier foods.

Increased physical activity with an emphasis on walking.

Reduced prevalence of commercial tobacco use.

Reduced incidence of type 2 diabetes.

Reduced prevalence of high blood pressure.

Component 3 Logic Model Bold Intermediate-term Outcomes indicates period of performance outcome.

Strategy: Establish a Tribal Coordinating Center (TCC) to collaborate with C1 and C2 recipients to foster peer-to-peer learning, share best- or promising-practices, coordinate national and local communication and evaluation efforts, and document success stories with measurable impact.

Activities Short-term Outcomes

(1-3 years) Intermediate-term Outcomes (3-5 years)

Long-term Outcomes (5+ years)

Coordinate the development and implementation of a communication strategy for promoting the value, impact, and

Increased number of promising practices and success stories identified that demonstrate a measurable impact of

Increased number of GHWIC promising practices and success stories disseminated among AI/AN communities.

Increased adoption of promising practices within AI/AN communities.

achievements of the GHWIC program.

the program.

Collaborate with CDC evaluators to develop and implement an evaluation plan for the national program, including the development of an evaluation measurement framework that includes performance measures for C1 and C2 recipients.

Increased number of C1 and C2 recipients using their data and evaluation findings to monitor progress in achieving the NOFO outcomes and to inform program improvements.

Increased number of recipients submitting data to CDC to evaluate the national program in aggregate.

Increased number of quality improvement activities implemented.

Develop and implement a coordinated, collaborative Community of Practice (CoP) focusing on chronic disease prevention, including oral health, to facilitate peer-to-peer learning, knowledge-sharing, problem-solving, and communication across the network using regular videoconferencing sessions.

Increased participation among C1 and C2 recipients in a collaborative virtual Community of Practice.

Increased number of promising practices, lessons learned, and success stories identified, shared, and implemented over time.

Increased implementation of promising practices within AI/AN communities.

i. Purpose The purpose of this NOFO is to reduce rates of death and disability from commercial tobacco use, diabetes, heart disease and stroke, reduce the prevalence of obesity, and prevention of other chronic disease risk factors and conditions (e.g., oral health, dementia, COPD) among American Indians and Alaska Natives.

ii. Outcomes

Component 1:

Strategy1: Implement evidence-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent obesity.

Increased number of people with access to healthy foods (e.g., fresh produce, low sodium options) and beverages.

Increased percent improvement in number of people with access to healthy foods (e.g., fresh produce, low sodium options) and beverages.

Increased number of people with access to safe and accessible places for physical activity.

Increased percent improvement in number of people with access to safe and accessible places for physical activity.

Increased number of breastfeeding mothers who use community services that support breastfeeding.

Increased percent improvement in number of breastfeeding mothers who use community services that support breastfeeding.

Strategy 2: Implement evidence-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent and control commercial tobacco use.

Increased number of workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings that implement commercial tobacco-free policies.

Increased percent improvement in number of workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings that implement commercial tobacco-free policies.

Increased number of commercial tobacco-using patients who receive commercial tobacco cessation interventions.

Increased percent improvement in number of commercial tobacco-using patients who receive commercial tobacco cessation interventions.

Strategy 3: Implement evidence-informed and culturally-adapted community-clinical linkages (CCL) to support type 2 diabetes prevention.

Increased number of community members at high risk for diabetes enrolled in CDC-recognized type 2 diabetes prevention programs offered in AI/AN communities.

Strategy 4: Implement evidence-informed and culturally-adapted community clinical linkages (CCL) to support heart disease and stroke prevention.

Increased number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Increased percent improvement in number of patients with high blood pressure or high blood cholesterol engaged in self-management and treatment programs.

Component 2:

Strategy: Provide funding, training, technical assistance, and evaluation support to Area

Tribes/Villages or UIOs conducting activities across all four C1 strategies.

Increased number of Area Tribes/Villages/UIOs implementing activities across all four C1 strategies (PSEs and CCLs). Note: Component 2 Recipients will be required to provide the name, funding amount, C1 activities conducted, and progress on C1 outcomes by each Tribe/Village/UIO subawardee funded through this NOFO.

Component 3:

Strategy: Establish a Tribal Coordinating Center (TCC) to collaborate with C1 and C2 recipients to foster peer-to-peer learning, share best- or promising-practices, coordinate national and local communication and evaluation efforts, and document success stories with measurable impact.

Increased number of GHWIC promising practices and success stories disseminated among AI/AN communities.

Increased number of recipients submitting data to CDC to evaluate the national program in aggregate.

Increased number of promising practices, lessons learned, and success stories identified, shared, and implemented over time.

iii. Strategies and Activities Component 1: Applicants must propose at least one activity from the policy, system, and environmental change (PSE) strategies (obesity or tobacco), one activity from the diabetes prevention community-clinical linkage (CCL) strategies, and one activity from the heart disease and stroke prevention community-clinical linkage strategies in their work plans (for a total of at least three activities).

Strategy 1: Implement evidenced-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent obesity.

Improve tribal food and beverage programs/systems (e.g., community gardens, farmers markets, public transportation routes to food stores, access to healthy foods at community venues or schools, using food service guidelines and nutrition standards).

Collaborate with partners to improve land use design to connect activity-friendly routes (e.g., sidewalks, bicycle routes, public transit) with everyday destinations (e.g., homes, schools, work sites, parks).

Increase continuity of care/community support for breastfeeding by incorporating services into existing community support services (e.g., early care and education centers, community health centers, home visiting programs); establishing culturally-appropriate and accessible lactation support services (e.g., support groups, walk-in clinics, Baby Cafés); and providing breast feeding support training to health care providers, community health workers, peer support providers, etc. that work with mothers and babies.

Strategy 2: Implement evidence-informed and culturally-adapted policy, system, and environmental changes (PSE) to prevent and control commercial tobacco use.

Implement commercial tobacco-free policies within workplaces, restaurants, bars, casinos, schools, multi-unit housing, indoor and outdoor events, celebrations and gatherings.

Provide referrals to evidence-based commercial cessation treatment, including counseling and FDA-approved medications.

Strategy 3: Implement evidence-informed and culturally-adapted community-clinical linkages (CCL) to support type 2 diabetes prevention.

Expand access to the National Diabetes Prevention Program (National DPP) lifestyle change program in tribal communities by:

Increasing awareness of prediabetes among tribal members and health care providers/health professionals (e.g., community wide events, educational campaigns, health-care provider/health professionals training);

Supporting prediabetes screening, testing, and referral to CDC-recognized type 2 diabetes prevention programs by health care teams, community partners, health paraprofessionals;

Establishing or expanding the reach of CDC-recognized type 2 diabetes prevention programs in AI/AN communities and promoting sustainability (e.g., assess existing resources, CDC-recognized programs offered by other organizations in the AI/AN community, and modes of program delivery options);

Developing culturally-relevant approaches to increase program participation and retention among AI/AN members (e.g., culturally-relevant materials, innovative retention strategies, community members trained as lifestyle coaches).

Strategy 4: Implement evidence-informed and culturally-adapted community clinical linkages (CCL) to support heart disease and stroke prevention.

Expand engagement of community health representatives and other health paraprofessionals to become effective members of chronic disease prevention/management teams within their local health care systems to manage and refer community members with or at high risk of high blood pressure or high blood cholesterol to appropriate and locally available health and preventive care programs.

Implement team-based care, including non-physician team members (e.g., nurses, pharmacists, patient navigators), in managing patients with or at risk for high blood pressure and/or high blood cholesterol.

Develop culturally-relevant materials and approaches to link tribal/village resources and clinical services to support prevention, detection, and control of high blood pressure and/or high blood cholesterol.

Component 2 Strategy: Provide funding, training, technical assistance, and evaluation support to all Area Tribes/Villages or UIOs conducting activities across all four C1 strategies.

Expand the implementation of Component 1 strategies and activities through subawards to at least four (4) additional Area Tribes/Villages or UIOs.

Provide technical assistance, training, and resources to all Area Tribes/Villages/UIOs to support the planning, development, implementation, and evaluation of activities across all four C1 strategies.

Assist Area Tribes/Villages/UIOs in developing multi-sector partnerships with organizations to support C1 strategies and activities in Tribes/Villages/UIOs.

Work with Area Tribes/Villages/UIOs to develop and implement tailored health communication/messaging strategies to reach AI/AN populations at greatest risk for obesity, commercial tobacco use, type 2 diabetes, and/or heart disease and stroke in order to increase awareness and encourage healthier behaviors.

Component 3 Strategy: Establish a Tribal Coordinating Center (TCC) to collaborate with C1 and C2 recipients to foster peer-to-peer learning, share best- or promising-practices, coordinate national and local communication and evaluation efforts, and document success stories with measurable impact.

Coordinate the development and implementation of a communication strategy for promoting the value, impact, and achievements of the GHWIC program.

Collaborate with CDC evaluators to develop and implement an evaluation plan for the national program, including the development of an evaluation measurement framework that includes performance measures for C1 and C2 recipients.

Develop and implement a coordinated, collaborative Community of Practice (CoP) focusing on chronic disease prevention, including oral health, to facilitate peer-to-peer learning, knowledge-sharing, problem-solving, and communication across the network using regular videoconferencing sessions.

1. Collaborations

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

Collaboration with programs funded by CDC is encouraged, particularly those that are working to mitigate risk factors associated with diabetes, heart disease, stroke, and obesity. National initiatives, guidelines, and policies have been identified from The Community Guide and CDC's Division of Nutrition, Physical Activity, and Obesity; Division of Diabetes Translation; Division for Heart Disease and Stroke Prevention; Division of Cancer Prevention and Control; Office on Smoking and Health; and Division of Oral Health that may complement and build on culturally-based, grounded approaches. Access http://www.cdc.gov/chronicdisease/index.htm for additional information on CDC's chronic disease programs.

Collaboration with tribal public health capacity building programs funded by the Center for State, Territorial, Local, and Tribal Support and others at CDC is also encouraged, particularly those that are working to strengthen public health infrastructure and advance quality improvement of tribal public health services. Access https://www.cdc.gov/publichealthgateway/partnerships/ for additional information on CDC's programs with national partners, tribal organizations, and to https://www.thecommunityguide.org/ http://www.cdc.gov/nccdphp/dnpao/index.html https://www.cdc.gov/diabetes/home/index.html http://www.cdc.gov/dhdsp/ http://www.cdc.gov/dhdsp/ https://www.cdc.gov/cancer/index.htm http://www.cdc.gov/tobacco/ http://www.cdc.gov/tobacco/ http://www.cdc.gov/dhdsp/ http://www.cdc.gov/chronicdisease/index.htm https://www.cdc.gov/stltpublichealth/ https://www.cdc.gov/stltpublichealth/ https://www.cdc.gov/publichealthgateway/partnerships/ promote infrastructure building.

Examples of CDC tribal programs that may provide collaboration opportunities to support achievement of Good Health and Wellness in Indian Country (GHWIC) outcomes include Building Public Health Infrastructure in Tribal Communities to Accelerate Disease Prevention and Health Promotion in Indian Country (also referred to as the Tribal Epidemiological Centers Public Health Infrastructure), and Tribal Practices for Wellness in Indian Country.

American Indian and Alaska Native populations have high rates of disability. Access https://www .cdc.gov/ncbddd/disabilityand health/index.html for additional information about disability inclusion and adaptive resources to help make GHWIC activities accessible for people with disabilities.

b. With organizations not funded by CDC:

Recipients are expected to collaborate with organizations external to CDC, such as those listed below, that are necessary to achieve project outcomes or that can enhance and accelerate achievement of project outcomes. Relationships with other potential partners, such as local and state health departments and relevant non-profit and provider groups, are encouraged. Building and/or continuing strategic partnerships and collaborations with organizations that have a role in achieving the long-term outcomes of this NOFO are encouraged. Examples include, but are not limited to, the following:

Indian Health Service (Health Promotion Disease Prevention) - https://www.ihs.gov/hpdp/ Indian Health Service Special Diabetes Program for Indians - https://www.ihs.gov/sdpi/ Federally Recognized Tribes Extension Program (FRTEP) - https://nifa.usda.gov/funding-opportunity/federally-recognized-tribes-extension-program-frtep-formerly-extension-india n

USDA (Rural Development grants: support housing, community facilities, and community and economic development projects in rural areas - https://www.rd.usda.gov /programs-services/rural-community-development-initiative-grants

Land Grant University (LGU) system, including tribal colleges - https://nifa.usda.gov/land -grant-colleges-and-universities-partner-website-directory

Food Distribution Program on Indian Reservations (FDPIR) nutrition education - http…