Among Us Portable
Darnell Rempe
There is a persistent but unfounded notion that between can be used only of two items and that among must be used for more than two. Between has been used of more than two since Old English; it is especially appropriate to denote a one-to-one relationship, regardless of the number of items. It can be used when the number is unspecified
Prepare for departure but beware the Impostor! Play with 4-15 players online or via local WiFi as you attempt to hold your spaceship together and survive, but be careful. One or more random players among the crew are Impostors bent on killing everyone!
All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.
The purpose of this Notice of Funding Opportunity (NOFO) is to support novel and innovative research that examines and/or intervenes on the underlying and multilevel causes, pathways, and factors adversely impacting the health and well-being of persons with disabilities at the intersections of race and ethnicity, and socioeconomic status.
There are several options available to submit your application through Grants.gov to NIH and Department of Health and Human Services partners. You must use one of these submission options to access the application forms for this opportunity.
NIH-designated Populations Experiencing Health Disparities: Racial and ethnic minority populations, socioeconomically disadvantaged populations, underserved rural populations, sexual and gender minority groups, and people living with disabilities in the U.S.
Disability: The Americans with Disabilities Act broadly defines a disability as a "physical or mental impairment that substantially limits one or more major life activities (e.g., mobility, cognition, independent living, vision, and self-care) and the ADA Amendments Act of 2008 that added "major bodily functions", to "Major Life Activities." This funding opportunity focuses on persons across the lifespan with congenital, developmental, cognitive, and physical disabilities (e.g., Down's syndrome, cerebral palsy, or injury-related physical impairment or amputation), as well as adults with early or premature onset of a major physical disability that causes long-term impairment or limit(s) functioning indefinitely.
Intersectional Approach: Intersectionality acknowledges that individuals have multiple, interconnected social identities (e.g., gender, racial group, class, sexual orientation, and disability), and these identities intersect to shape their unique experiences and positions within society. For example, intersectionality highlights how racial and ethnic minority persons living with a disability may experience a unique set of challenges that require a more comprehensive approach to addressing discrimination and promoting health equity. Taking an intersectional approach can better predict variations in health outcomes and determine individual or population needs, and ultimately lead to more inclusive and/or multi-level research.
The population of persons living with disabilities in the United States is heterogeneous, estimated at 24-26% of adults and 4.3% of children from various backgrounds, life circumstances, and health conditions. Impaired mobility (13.7%), cognition (10.8%), and independent living (6.8%) are the most common disabilities among adults, and impaired cognition (4.4%) is most common among children. Data indicate that, on average, individuals living with disabilities have poorer health-related quality of life and overall health, as well as decreased healthy life expectancy and longevity compared with people without a disability. Adults living with disabilities have a higher prevalence of preventable, chronic, and complicating comorbidities compared with the overall adult population. Examples include obesity (38.2% versus 26.2%), tobacco smoking (28.2% versus 13.4%), diabetes (16.3% versus 7.2%), and heart disease (11.5% versus 3.8%). Among persons of childbearing age, 12% live with at least one disability and are at a higher risk for maternal morbidity and mortality. Additionally, the objective signs and subjective experiences of persons living with disabilities are often dynamic, changing in nature, quality, and severity over time.
The focus of this notice of funding opportunity (NOFO) is to emphasize research at the intersection of disabilities, race and ethnicity, and socioeconomic status (SES) in persons with developmental and physical disabilities. Among racial and ethnic minority groups, the prevalence of living with at least one disability is markedly greater in American Indian and Alaska Native (30%) and Black or African American (25%) populations compared to 20% of White persons. Irrespective of racial and ethnic group, economically disadvantaged persons with disabilities are more likely to experience diminished opportunities for effective independent living driven by factors such as unemployment, adverse living conditions, housing instability, food insecurity, transportation limitations, social isolation, disaster unpreparedness, and low quality of healthcare. Additionally, residents of underserved rural communities are 9% more likely to have any disability and 24% more likely to report having three or more disabilities compared with adults in urban areas. Individuals living with disabilities, who reside in rural areas may also face barriers to healthcare access, accessible transportation, and high-quality education, and vocational or rehabilitation services. Research among sexual and gender minority persons with disabilities is scarce, although it is likely that commonly experienced barriers to accessing culturally competent physical, psychiatric, and specialty healthcare are intensified.
Furthermore, adverse social determinants of health (SDOH) amplify the challenges of health and health-related quality of life (QoL) among youth and adults living with disabilities. Examples include lack of accessible transportation or building entry/navigation, discrimination related to ableism, and clinical misperceptions within healthcare systems that may greatly complicate healthcare access and quality. Moreover, inaccessible and/or non-adaptive clinical facilities, equipment, and communication mechanisms, as well as non-inclusive clinical care guidelines and procedures impede equitable access to appropriate healthcare or lead to erroneous attribution of symptoms related to the primary disability rather than a new or co-occurring diagnosis or health crisis. Greater study is needed to inform appropriate or adaptable clinical practice guidelines for persons living with disabilities with an intersectional lens, as well as to enhance the understanding of the health and health risk behaviors (e.g., alcohol and substance use, prescription misuse, self-injurious behaviors, and interpersonal violence) over the life course. Overall, more expansive research is needed to elucidate the discrete differences, areas of overlap, relationships among factors across the lifespan, and severity of health outcomes across and within populations with health disparities. Therefore, this funding opportunity strongly encourages collaborative, mechanistic, clinical, or interventional research, implementation or translational science, and/or the use of data science research approaches in intersectional areas of study.
The overarching goals of this funding opportunity are to support innovative research that focuses on the health (e.g., conditions, outcomes, trajectories, etc.) and healthcare (e.g., modalities systemic or structural factors, access/barriers, service delivery, care quality, utilization, etc.) of persons living with disabilities and the intersections with race and ethnicity, and SES. Research focused on intersections with sexual and gender minority self-identification, and living in underserved rural locations are also of interest.
Projects may include the study of comorbid or co-occurring conditions (e.g., acute infections or chronic diseases); adaptive and maladaptive behaviors; prevention of or interventions for health risks; tailored or innovative health care processes, structures, or systems; healthcare delivery model effectiveness; and clinicians and other health care workers practices and/or biases.
Applications are expected to provide a conceptual model that describes or hypothesizes causal pathways by which clinicians and other healthcare professionals, services, or systems engage persons with disabilities to mitigate health risks, improve health outcomes, reduce health disparities, or compliment health care system.
Applications are encouraged to address more than one level of analysis (e.g., individual, interpersonal, institutional, community, and policy levels), as illustrated in the NIMHD Research Framework. They should also consider factors that will facilitate or serve as barriers to sustainability and/or adoption of healthcare models, practices, or guidelines. Resulting research initiatives will support science that advances our understanding of and efforts to mitigate the underlying causes and pathways adversely impacting the populations of focus.
Research projects for this NOFO can consist of studies that are clinical science, behavioral, epidemiological, evaluative, or observational, as well as implementation studies, pragmatic trials, and cluster randomized trials to assess health care provision, models, delivery, services, and systems in metropolitan or rural areas, regionally, and/or nationally, including the U.S. territories. Projects can involve primary data collection and/or secondary analyses of linked datasets. Projects can include research collaborations across multiple health care settings and academic institutions.
Investigators are strongly encouraged to work collaboratively with community leaders, community-based organizations, and other relevant stakeholders and/or supporting persons with disabilities to support in-depth examination of physical, social, behavioral, ethical, structural, environmental, and policy factors. Community partnerships (e.g., tribal leadership, academic, private, safety-net health systems, community organizations, public health departments, state and local governments, health care professionals, faith-based organizations, and school or childcare settings) are strongly encouraged. Applicants proposing community-engaged research should document existing collaboration with or support from community organizations. Study budgets should provide appropriate levels of funding for community partners commensurate with the roles and level of effort of the community partners in research design and implementation, if applicable.
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