Notice of Intent to Publish a Funding Opportunity Announcement for Understanding the Intersection of Social Inequities to Optimize Health and Reduce Health Disparities: The Axes Initiative (R01 Clinical Trial Optional)

Purpose

The purpose of this notice is to inform the research community that the National Institute of Nursing Research (NINR), with other NIH Institutes, Centers, and Offices (ICOs) listed above, intends to publish a notice of funding opportunity (NOFO), Understanding the Intersection of Social Inequities to Optimize Health and Reduce Health Disparities: The Axes Initiative (R01 Clinical Trial Optional).

This Notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive projects.

This NOFO will utilize the R01 activity code. Details of the planned NOFO are provided below.

Research Initiative Details

The Axes Initiative invites applications to examine the pathways and mechanisms through which social determinants of health (SDOH), and related biological, psychological, and behavioral factors impact health and health disparities at intersections of privileged or oppressed social statuses such as race, ethnicity, socioeconomic status, sexual orientation, and ability. SDOH is a key pathway of interest, therefore examination of federal, state, local, or organizational level policies, programs, or practices, and/or conditions of daily life (e.g., concentrated disadvantage, quality employment and education, housing, and food) on health outcomes at intersections of social statuses is required. Studies can incorporate biological, psychological, and behavioral factors, as well as individual and family economic and social circumstances to elucidate proximal pathways and mechanisms through which SDOH influence health at social status intersections. Studies that incorporate novel methods, measures, and analytical approaches that account for the complexity of intersectionality research are encouraged.

The primary populations of focus for the Axes Initiative are those that experience health disparities in the U.S., including racial and ethnic minority populations, people with lower socioeconomic status, underserved rural populations, sexual and gender minority populations, and people with disabilities. Inclusion of social statuses such as gender and gender identity, biological sex, national origin, and immigration status are also of interest. Studies must clearly convey the populations of interest for the proposed research and how the populations comprise intersecting statuses that are privileged and/or have been oppressed.

All studies must be guided by an intersectionality framework to identify the hypothesized pathways and mechanisms between intersecting social statuses and health outcomes. As appropriate, involvement of the priority populations in the research process, through for example formation of a community advisory board, focus groups and interviews, listening sessions, or community forums, to increase the relevance and resonance of study findings are encouraged. Projects may utilize primary data collection and/or analysis of secondary data from project-specific or publicly available data sources at the federal, state, local, or organizational level and across sectors such as healthcare, human and social services, housing, justice, commerce, transportation, economic development, and education. Observational research, evaluation studies, simulation studies, and predictive modeling studies are of interest. Also of interest are mixed-methods studies that combine quantitative and qualitative data to contextualize intersectional forms of privilege or oppression. Projects using longitudinal study designs are strongly encouraged. The primary health outcome may reflect health or functional status, health conditions, quality of life, and/or morbidity and mortality.

Examples of projects that may be supported by the Axes Initiative include, but are not limited to: 

• Comparative studies that examine similarities and differences in pathways and mechanisms of health and health disparity impacts across intersectional statuses.
• Studies that focus on embodiment or biological embedding, i.e., how exposure to various forms of privilege and oppression converge to affect SDOH experienced by people at intersections of social statuses and, in turn, effect underlying biological processes (e.g., epigenome, allostatic load, inflammation, microbiome, neurological signatures).
• Longitudinal and life course studies that examine pathways and mechanisms over time and across generations at intersections of social statuses.
• Studies that examine the multilevel pathways and mechanisms through which concentrated disadvantage impacts health at different intersections of social statuses.
• Studies that examine pathways and mechanisms to explain unexpected positive health outcomes across intersecting social statuses.
• Studies that identify protective factors at multiple levels (e.g., individual, interpersonal, institutional, community, societal) and the ways these protective factors buffer effects of oppression on health disparities.
• Studies that examine the differential impact of policies and laws at the federal, state, and/or local levels at varied axes of privilege and oppression.
• Simulation studies that estimate the impacts of strategies to ameliorate adverse or positive SDOH to reveal pathways or mechanisms of action that effect change at the individual, community, and population levels.