This Program Announcement expires on April 6, 2005, unless reissued.
NATIONAL INSTITUTE OF NURSING RESEARCH NATIONAL RESEARCH SERVICE AWARD
INDIVIDUAL PREDOCTORAL FELLOWSHIPS
Release Date: November 26, 2001
PA NUMBER: PAR-02-019 June 4, 2010 - This PAR has been reissued as (PAR-10-211).
(This PA has been replaced, see PAR-05-091)
(Extension of Receipt Date and Submission Instructions, see NOT-NR-05-001)
National Institute of Nursing Research
This is a revision and replacement of program announcement PA-99-017, which was
published in the NIH Guide, November 19, 1998.
PURPOSE
The Congress of the United States enacted the National Research Service Act
(NRSA) Program in 1974 to help ensure that highly trained scientists would be
available in adequate numbers and in appropriate research areas to carry out the
Nation"s biomedical and behavioral research agenda. Under this congressional
authority, the National Institute of Nursing Research (NINR) awards NRSA
Individual Predoctoral Fellowships (F31) to the most promising nursing
applicants enrolled in doctoral programs. Up to five years of aggregate NRSA
support may be provided. The proposed NRSA training must be within the scope of
biomedical or behavioral research relevant to the NINR mission and must offer an
opportunity for research training. Individuals are required to pursue their
research training on a full-time basis, devoting at least 40 hours per week to
the training program.
NIH recognizes the critical importance of training clinicians to become
researchers and encourages them to apply. Women, minorities, and individuals
with disabilities are also encouraged to apply. An NRSA Award may not be used to
support studies leading to the M.D., D.O., D.D.S., D.V.M., or other similar
health-professional degrees. Neither may this award be used to support the
clinical years of residency training.
HEALTHY PEOPLE 2010
The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2010," a PHS-led national
activity for setting priority areas. This Request for Applications (RFA), NINR
Career Transition Award, is related to one or more of the priority areas.
Potential applicants may obtain a copy of "Healthy People 2010" at
http://www.health.gov/healthypeople/.
ELIGIBILITY REQUIREMENTS
Citizenship. By the time of award, individuals must be citizens or noncitizen
nationals of the United States, or have been lawfully admitted to the United
States for permanent residence (i.e., possess a currently valid Alien
Registration Receipt Card I-551, or other legal verification of such status).
Noncitizen nationals are generally persons born in outlying possessions of the
United States (e.g., American Samoa and Swains Island). Individuals on
temporary or student visas are not eligible.
Degree Requirements. Applicants must be registered nurses (R.N.) enrolled in
doctoral programs or have been accepted by and agreed to enroll in such a
graduate program in the academic year in which funds are awarded.
Sponsorship. As part of the fellowship application process, certification by an
authorized official of the degree-granting institution that the R.N. applicant
is enrolled in the sponsoring institution"s doctoral program is required.
Before submitting a fellowship application, the applicant must identify a
sponsoring institution and an individual who will serve as a sponsor (also
called mentor) and will supervise the training and research experience.
The applicant"s sponsor should be an active investigator in the area of the
proposed research who will directly supervise the candidate"s research. The
sponsor must document the availability of staff, research support, and
facilities for high-quality research training. The applicant must work with
his/her sponsor in preparing the application.
Foreign Sponsorship. Applicants requesting foreign training must show in the
application that the foreign institution and sponsor offer unique opportunities
that are not currently available in the United States. Only if there is a clear
scientific advantage will foreign training be supported.
The institutional setting must be domestic, and may be a private (profit or
nonprofit) or public academic institution.
MECHANISM OF SUPPORT
This program announcement for the Individual Predoctoral Fellowship Award (F31)
is issued under the auspices of the NRSA Act (see AUTHORITY AND REGULATIONS).
Awards will be administered under the National Institutes of Health (NIH) Grants
Policy Statement, which includes the NRSA Guidelines for Individual Awards found
at https://grants.nih.gov/grants/policy/policy.htm. The NRSA Guidelines for
Individual Awards and Institutional Grants is available on the NIH Website at:
https://grants.nih.gov/training/nrsa.htm
Period of Support
The period of fellowship support requested in response to this PA may not exceed
five years. Continuation of the fellowship award for each subsequent year beyond
the first award period is based upon evidence of satisfactory progress in a
graduate program. (Note: the total period of predoctoral training support is
limited to 5 years by statute, 42 USC 288, except in unusual circumstances.)
The recipient of predoctoral fellowship support must submit a written request to
waive this limit on the duration of support from the NINR.
RESEARCH TRAINING OBJECTIVES
NINR is committed to increasing the number of doctorally-prepared nurses in
order to meet the demands for adequately trained biobehavioral scientists. NINR
is particularly interested in facilitating the progress of students who are in
creative research training programs for recent nursing graduates and students in
BSN to PhD programs.
This program will provide predoctoral training support for doctoral students.
The applicant must propose a research training program and dissertation research
that is consistent with the scientific mission of the NINR. The research
training experience must enhance the applicant"s conceptualization of research
problems and research skills, under the guidance and supervision of a committed
mentor who is an active and established investigator in the area of the
applicant"s proposed research. The research training program should be carried
out in a research environment that includes appropriate human and technical
resources and is demonstrably committed to the research training of the
applicant in the program he/she proposes in the application.
ALLOWABLE COSTS
The fellowship award provides an annual stipend to help meet the fellow"s living
expenses, an allowance for tuition and fees and health insurance in accordance
with NIH policy, and an annual institutional allowance.
Stipend. The stipend amount is updated from time-to-time and applicants are
advised to search the NIH Guide for Grants and Contracts for the most current
rate or for the posting of the current stipend on the NIH website at
https://grants.nih.gov/training/nrsa.htm by following the NRSA Stipends link.
NINR will adjust awards as the stipend changes.
Tuition, Fees, and Health Insurance. NINR will offset the combined cost of
tuition, fees, and health insurance (either self-only or family as appropriate)
at the following rate: 100 percent of all costs up to $3,000 and 60 percent of
costs above $3,000. Costs associated with tuition and fees are allowable only if
they are required for specific courses in support of the research training
experience supported by the fellowship. A full description of the tuition policy
is contained within the NRSA Policy Guidelines on the NIH website at
https://grants.nih.gov/training/nrsaguidelines/nrsa_toc.htm.
Institutional Allowance. An institutional allowance of $2,500 per 12-month
period will be awarded to non-Federal, non-profit sponsoring institutions to
help defray such awardee expenses as research supplies, equipment, travel to
scientific meetings, and related items. This allowance is intended to cover
training-related expenses for the individual awardee and is not available until
the fellow officially activates the award. If the fellow is not enrolled or
engaged in training for more than 6 months of the award year, only one-half of
that year"s allowance may be charged to the grant. The Notice of Research
Fellowship Award will be revised, and the balance must be refunded to NINR.
Other Training Costs. Additional funds may be requested by the institution if
the training of a fellow involves extraordinary costs for: (1) travel to field
sites remote from the sponsoring institution, or (2) accommodations for fellows
with disabilities, as defined by the Americans with Disabilities Act. The funds
requested for these additional costs must be reasonable in relationship to the
total dollars awarded under the F31. Such additional funds shall be provided
only in exceptional circumstances that are fully justified and explained by the
institution.
Funds are not available to cover the cost of travel between the fellow"s place
of residence and a training institution. However, in cases of extreme need or
hardship, a one-way travel allowance may be authorized by NINR. Such travel
must be paid from the institutional allowance.
Awards for training at a foreign site may include, in addition to the
institutional allowance, a single economy or coach round-trip travel fare. No
allowance is provided for dependents. U.S. flag carriers must be used to the
maximum extent possible when commercial air transportation is available for
travel between the United States and a foreign country or between foreign
countries.
Facilities and Administrative Costs. F&A (indirect) costs are not awarded on
individual fellowship awards.
STIPEND SUPPLEMENTATION, COMPENSATION, AND OTHER INCOME
An institution is permitted to provide funds to a fellow in addition to the
stipend paid by the NIH. Such additional amounts may be in the form of
augmented stipends (supplementation) or compensation for services.
Supplementation. Supplementation or additional support to offset the cost of
living may be provided by the sponsoring institution, but must not require any
additional effort from the fellow. Federal funds may not be used for
supplementation unless specifically authorized under the terms of both the
program from which such supplemental funds are to be received and the program
whose funds are to be supplemented. Under no circumstances may DHHS grant funds
be used for supplementation.
Compensation. An institution may provide additional funds to a fellow in the
form of compensation (as salary and/or tuition remission) for services such as
teaching or laboratory assistantships. Compensation for services is not
considered stipend supplementation. A fellow may receive compensation for
services as a research assistant or in some other capacity on a Federal research
grant, including a PHS research grant. However, compensated services must occur
on a limited, part-time basis apart from the normal training activities, which
require a minimum of 40 hours per week. In addition, compensation may not be
paid from a research grant supporting research that is part of the F31 research
training experience.
Under no circumstances may the conditions of stipend supplementation or the
services provided for compensation interfere with, detract from, or prolong the
fellow"s approved NRSA training program. Additionally, compensation must be in
accordance with institutional policies applied consistently to both federally
and non-federally supported activities and supported by acceptable accounting
records determined by the employer-employee relationship agreement.
Educational Loans or G.I. Bill. An individual may make use of Federal
educational loan funds and assistance under the Veterans Readjustment Benefits
Act (G.I. Bill). Such funds are not considered supplementation or compensation.
Concurrent Awards. An F31 may not be held concurrently with another Federally
sponsored fellowship or similar Federal award that provides a stipend or
otherwise duplicates provisions of the NRSA.
Tax Liability. The Internal Revenue Code, Section 117, applies to the tax
treatment of all scholarships and fellowships. Degree candidates may exclude
from gross income reported for tax purposes any amount used for tuition and
related expenses, such as fees, books, supplies, and equipment, required for
courses of instruction at a qualified educational organization.
The taxability of stipends, however, in no way alters the relationship between
NRSA fellows and institutions. NRSA stipends are not considered salaries. NRSA
fellows are not considered to be in an employee-employer relationship with the
NIH or with the institution at which they are pursuing their degree.
The interpretation and implementation of the tax laws are the domain of the
Internal Revenue Service (IRS) and the courts. The NIH takes no position on the
status of a particular taxpayer, and it does not have the authority to dispense
tax advice. Individuals should consult their local IRS office about the
applicability of the law to their situation and for information on the proper
steps to be taken regarding their tax obligations.
The business office of the sponsoring institution is not required to issue IRS
Form 1099 (Statement of Miscellaneous Income) for fellows paid through the
institution, however, institutions may choose to issue the form as a reminder
for fellows. NIH will issue the form for all fellows training at Federal or
foreign laboratories and receiving a stipend check from the U.S. Treasury.
PAYBACK
There are no payback requirements for predoctoral NRSA support.
LEAVE
Predoctoral fellows may continue to receive stipends during periods of vacation
and holidays available to individuals in comparable training positions at the
sponsoring institution. Also, predoctoral fellows may continue to receive
stipends for up to 15 calendar days of sick leave per year. Sick leave may be
used for the medical conditions related to pregnancy and childbirth. Fellows may
continue to receive stipends for up to 30 calendar days of parental leave per
year for the adoption or the birth of a child when those in comparable training
positions at the grantee or sponsoring institution have access to paid leave for
this purpose and the use of parental leave is approved by the sponsor. A period
of terminal leave is not permitted and payment may not be made from grant funds
for leave not taken. Individuals requiring extended periods of time away from
their research training experience must seek approval from the NINR for an
unpaid leave of absence.
INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS
It is the policy of the NIH that women and members of minority groups and their
sub-populations must be included in all NIH-supported clinical research projects
unless a clear and compelling justification is provided indicating that
inclusion is inappropriate with respect to the health of the subjects or the
purpose of the research. This policy results from the NIH Revitalization Act of
1993 (Section 492B of Public Law 103-43).
All investigators proposing clinical research should read the AMENDMENT "NIH
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research - Amended, October, 2001," published in the NIH Guide for Grants and
Contracts on October 9, 2001
(https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html),
a complete copy of the updated Guidelines are available at
https://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.
The amended policy incorporates: the use of an NIH definition of clinical
research, updated racial and ethnic categories in compliance with the new OMB
standards, clarification of language governing NIH-defined Phase III clinical
trials consistent with the new PHS Form 398, and updated roles and
responsibilities of NIH staff and the extramural community. The policy
continues to require for all NIH-defined Phase III clinical trials that: a) all
applications or proposals and/or protocols must provide a description of plans
to conduct analyses, as appropriate, to address differences by sex/gender and/or
racial/ethnic groups, including subgroups if applicable, and b) investigators
must report annual accrual and progress in conducting analyses, as appropriate,
by sex/gender and/or racial/ethnic group differences.
INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS
It is the policy of NIH that children (i.e., individuals under the age of 21)
must be included in all human subjects research, conducted or supported by the
NIH, unless there are scientific and ethical reasons not to include them. This
policy applies to all initial (Type 1) applications submitted for receipt dates
after October 1, 1998.
All investigators proposing research involving human subjects must read the "NIH
Policy and Guidelines on the Inclusion of Children as Participants in Research
Involving Human Subjects" that was published in the NIH Guide for Grants and
Contracts, March 6, 1998, and is available at the following URL address:
https://grants.nih.gov/grants/guide/notice-files/not98-024.html
Investigators also may obtain copies of these policies from the program staff
listed under INQUIRIES. Program staff may also provide additional relevant
information concerning the policy.
PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT
The Office of Management and Budget (OMB) Circular A-110 has been revised to
provide public access to research data through the Freedom of Information Act
(FOIA) under some circumstances. Data that are (1) first produced in a project
that is supported in whole or in part with Federal funds and (2) cited publicly
and officially by a Federal agency in support of an action that has the force
and effect of law (i.e., a regulation) may be accessed through FOIA. It is
important for applicants to understand the basic scope of this amendment. NIH
has provided guidance at:
https://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.
Applicants may wish to place data collected under this PA in a public archive,
which can provide protections for the data and manage the distribution for an
indefinite period of time. If so, the application should include a description
of the archiving plan in the study design and include information about this in
the budget justification section of the application. In addition, applicants
should think about how to structure informed consent statements and other human
subjects procedures given the potential for wider use of data collected under
this award.
URLS IN NIH GRANT APPLICATIONS OR APPENDICES
All applications and proposals for NIH funding must be self-contained within
specified page limitations. Unless otherwise specified in a NIH solicitation,
Internet addresses (URLs) should not be used to provide information necessary to
the review because reviewers are under no obligation to view the Internet sites.
Reviewers are cautioned that their anonymity may be compromised when they
directly access an Internet site.
REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS
NIH policy requires education on the protection of human subject participants
for all investigators submitting NIH proposals for research involving human
subjects. This policy announcement is found in the NIH Guide for Grants and
Contracts Announcement dated June 5, 2000, at the following website:
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.
APPLICATION PROCEDURES
Individuals must submit the application form, PHS Individual National Research
Service Award (PHS 416-1, rev. 12/98), and include at least three letters of
reference. If the applicant has been lawfully admitted to the United States for
permanent residence, the appropriate item should be checked on the Face Page of
the application. Applicants who have applied for and have not yet been granted
admission as a permanent resident should check the Permanent Resident block on
the Face Page of the PHS 416-1 application, and also write in the word
"pending." A notarized statement documenting legal admission for permanent
residence must be submitted prior to the issuance of an award.
Potential applicants are STRONGLY ENCOURAGED to consult with one of the NINR
program staff listed under INQUIRIES prior to submitting an application.
For further assistance contact GrantsInfo, Telephone 301/710-0267, Email:
GrantsInfo@nih.gov.
All fellowship applications submitted in response to this Program Announcement
must identify the number PAR-02-019 in Item 3.
The following MUST be included with the application at the time of submission.
Failure to include any of these items may delay review of the application:
o THREE reference letters in sealed envelopes must be affixed to the original
face page of the application. The sponsor cannot be used as a reference.
APPLICATIONS SUBMITTED WITHOUT THREE REFERENCE LETTERS WILL BE RETURNED WITHOUT
REVIEW.
o a copy of the results of the Graduate Record Examination must be included at
the end of the application,
o a clear and legible copy of the applicant"s transcript(s) from all
undergraduate and graduate institutions in which the applicant is/has been
enrolled must be included at the end of the application,
o a description of the graduate or combined degree program in which the
applicant is either enrolled or has been admitted and agreed to enroll must be
included as Item 34 of the application.
o a description of plans to receive instruction in the responsible conduct of
research must be included in Item 34. No award will be made if an application
lacks this component.
Concurrent Applications. An individual may not have more then one individual
NRSA fellowship or comparable application pending review or award at the NIH or
other DHHS agencies at the same time.
The Individual (F31) NRSA Fellowship application undergoes a review process that
takes between 5 and 8 months. The three annual review cycles are as follows:
Application Receipt Date: April 5, 2005
Initial Review Date: June/July 2005
Secondary Review Date: Aug/Sep 2005
Anticipated Date of Award: Dec 1, 2005
INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. APPLICATIONS MUST ALSO FOLLOW
GUIDELINES REGARDING FONT SIZE AND OTHER APPLICATION INSTRUCTIONS, for example
the NIH Guide Notice NOT-OD-01-037 at
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-037.html
SUBMISSION
Submit a signed, typewritten original of the application (including the
Checklist, Personal Data form, at least three sealed reference letters, and all
other required materials) and two (2) exact, clear, single-sided photocopies of
the signed application, in one package to:
CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040
BETHESDA, MD 20892
BETHESDA, MD 20817 (express mail)
(a mailing label is included in the PHS 416-1 application kit)
REVIEW CONSIDERATIONS
Applications that are complete and responsive to the purpose of this program
will receive two sequential levels of review. The first level is an assessment
of scientific and technical merit by a peer review group composed primarily of
senior non-government nurse scientists selected for their research and research
training expertise in particular substantive domains. After this initial review
meeting, the Scientific Review Administrator (SRA), a designated Federal
official who coordinates the review of applications, prepares a written summary
of the peer review group"s evaluation of each application. This evaluation
serves as the foundation for a second level of review by the NINR Division of
Extramural Activities, which precedes funding decisions.
It is anticipated that individual predoctoral fellowship applications will be
received from candidates at varying points in their doctoral education, ranging
from initial acceptance into graduate studies through the completion of
coursework. Appropriate review requires that the application accurately reflect
the candidate"s progress through the doctoral program. This is particularly
important for candidates who are enrolled in BSN-PhD programs. Such information
is critical for an appropriate review of the entire application, including the
research proposal component. Thus, candidates should distinguish clearly between
completed and proposed coursework, required and elective courses, and both
describe and explain the relevance of all courses and research experiences to
the candidate"s short- and long-term research and/or career objectives. To
further assist reviewers in evaluating the candidate"s progress in graduate
studies, applications also should include a timeline for the completion of
coursework, preliminary/comprehensive examinations, and the doctoral degree.
Review Criteria
The F31 individual predoctoral fellowship is a research training award designed
to prepare future generations of outstanding scientists for research careers
relevant to the NINR scientific and public health mission. Major considerations
in the review of each application include the candidate"s potential for a
productive career, the candidate"s need for the proposed training, and the
degree to which the research training proposal, the sponsor, and the environment
will satisfy those needs. Reviewers are instructed to consider the following
factors in evaluating the overall merit of each application:
Candidate
o the candidate"s previous undergraduate and graduate education, degrees, and
academic performance,
o relevant research experience, awards and honors, professional training, and
publications,
o evidence of the candidate"s commitment to a research career,
o letters of reference regarding the candidate"s qualifications, commitment, and
scientific potential,
Research Training Plan
o clarity and specificity of, and justification for the candidate"s proposed
research training needs,
o adequacy of the objectives, design, and components of the research training
plan for meeting the candidate"s research training needs, including coursework
and individualized supervised research experiences,
o adequacy of plans to provide training in the responsible conduct of scientific
research,
o for students who have advanced to candidacy, the inclusion of the names of
dissertation committee members and the relevance of their expertise to the
research training plan,
o potential of proposed research training to serve as a sound foundation that
will lead the candidate to a productive research career in scientific areas
related to the NINR mission,
Research Proposal
o clarity, specificity, and scientific significance of the candidate"s stated
research interests, questions, and objectives,
o organization, coherence, and thoroughness of the candidate"s critical review
and synthesis of the literature in support of the stated research interests,
questions, and objectives,
o adequacy and feasibility of the proposed research design, including methods,
measures, procedures, sample composition, subject recruitment, and data analytic
plans. Details and specificity of the research design should be commensurate
with the candidate"s level of research experience, training, and completed
coursework,
o adequacy of plans for the protection of human subjects, animals, and the
environment, to the extent they may be adversely affected by the research
proposed,
o adequacy of plans to include women, children and minorities as subjects in
research, if applicable,
Sponsor:
o qualifications of the sponsor as a researcher, including history of
publications and successful competition for research support,
o the goodness of fit between the research interests of the candidate and
scientific experience and expertise of the sponsor(s),
o evidence of the proposed sponsor"s understanding of and commitment to
fulfilling the role of sponsor and mentor,
o evidence of the sponsor"s understanding of the candidate"s research training
needs, and the ability to assist in meeting those needs,
o past research training record of the sponsor in terms of the rate at which
former predoctoral trainees or graduate students have obtained their doctoral
degrees and pursued scientific careers,
Institutional Environment/Commitment:
o adequacy of the research training environment, including the level of
institutional commitment to research training and career development, the
quality of the facilities and related resources and infrastructure (e.g.,
equipment, laboratory space, computer time, subject populations) and the
availability of research support.
AWARD CRITERIA
NINR staff use the following criteria in making awards:
(1) eligibility of the applicant,
(2) the recommendation of the overall merit of the application by the peer
review study section,
(3) the relevance of the application to the Institute"s research priorities and
program balance, and
(4) the availability of funds.
Activation. No funds may be disbursed until the fellow has started training
under the award and an Activation Notice (PHS 416-5) has been submitted to the
NINR. An awardee has up to 6 months from the issue date on the Notice of
Research Fellowship Award to activate the award. Under unusual circumstances,
NINR may grant an extension of the activation period upon receipt of a specific
request from the fellow.
A complete listing of the NRSA terms and conditions of support may be found at:
https://grants.nih.gov/training/nrsa.htm
INQUIRIES
Inquiries are encouraged. The opportunity to clarify any issues or questions
from potential applicants is welcome.
Direct inquiries regarding programmatic issues to one of the NINR Program
Directors listed according to areas of science on the following web site:
http://www.ninr.nih.gov/ResearchAndFunding/DEA/OEP/AreasofscienceFile.htm
For inquiries regarding fiscal matters, contact:
Ms. Cindy McDermott
Office of Grants and Contracts Management
National Institute of Nursing Research
Building 45, Room 3AN-12
Bethesda, MD 20892-6300
Telephone: (301) 594-6869
FAX: (301) 480-8260
Email: cindy_mcdermott@nih.gov
AUTHORITY AND REGULATIONS
This program is described in the Catalog of Federal Domestic Assistance No.
93.361. Awards are made under authorization of sections 301 and 405 of the
Public Health Service Act as amended (42 USC 241 and 284) and administered under
NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and
92. This program is not subject to the intergovernmental review requirements of
Executive Order 12372 or Health Systems Agency review.
The PHS strongly encourages all grant and contract recipients to provide a
smoke-free workplace and promote the non-use of all tobacco products. In
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities (or in some cases, and portion of a facility) in which
regular or routine education, library, day care, health care or early childhood
development services are provided to children. This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.