NURSING RESEARCH CENTER CORE GRANTS Release Date: September 4, 1998 RFA: NR-99-001 P.T. National Institute of Nursing Research Letter of Intent Receipt Date: December 14, 1998 Application Receipt Date: January 14, 1999 PURPOSE The National Institute of Nursing Research (NINR) invites applications for research center core grants in key clinical and basic areas of nursing research that establish a scientific basis for the care of individuals across the life span. The Nursing Research Center Core grants (NRCC) will provide the infrastructure to centralize resources and facilities to support an active center of excellence in a specific area of inquiry that has a strong base of research funding. By developing infrastructure components, a number of established and independently funded investigators and their teams will have the opportunity to enhance their collective productivity to a greater degree than would be possible from each of their separately funded projects. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This Request for Applications (RFA), Nursing Research Center Core Grants, is related to the priority areas of maternal and child health, acute and chronic disabling conditions, HIV infections and sexually transmitted diseases, health promotion and disease prevention topics, and women"s health issues. Potential applicants may obtain a copy of "Healthy People 2000" at http://www.crisny.org/health/us/health7.html. ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State or local governments, and eligible agencies of the Federal Government. Foreign institutions are not eligible for the center program grants. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. Institutions eligible for the Nursing Research Center Core Grants are those at which there are at least three projects funded by Department of Health and Human Services (DHHS) research support grants from selected mechanisms (specifically, R01, R15, R18, R29, P01, P20, P50, U01) or comparable peer reviewed research projects (including those funded by State governments and private foundations) related to the scientific area of nursing inquiry. Each of these projects must have at least one year of committed support remaining at the time of the application receipt date. At least two of the projects must be in the college or school of nursing or department of nursing. A larger number of NIH awards in the scientific area of inquiry for the active center of excellence would strengthen an application. Institutions with centers grants funded from previous NINR RFAs are eligible. Only one NRCC application will be accepted from any single applicant organization. Joint applications will not be accepted from investigators at neighboring, independent institutions, but subcontracts are allowed if their usage enhances the development of the scientific area of inquiry and stays within the dollar limits of the RFA. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) research center core grant mechanism (P30). The purpose of this mechanism is to support shared resources and facilities for a specific area of scientific inquiry by a number of investigators who provide an interdisciplinary approach to a joint research effort or who focus on a common research problem. The centers grant is funded independently from the currently funded projects but is integrated with them to provide support. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The total project period for an application submitted in response to this RFA may not exceed five years. This RFA is a one-time solicitation. NINR plans to reissue this announcement annually subject to availability of funds. Support for NRCC awardees may be renewed in competing continuation applications pending future NRCC RFAs. The anticipated award date is July 1999. FUNDS AVAILABLE The NINR intends to commit approximately $2,100,000 in FY 1999 to fund seven to nine new and/or competitive continuation grants in response to this RFA. An applicant may request a project period of three to five years and a budget for total costs (direct and indirect) of up to $300,000 for the first year. Centers in early stages of development might find it easier to justify lesser amounts (such as $150,000 per year) in the developmental period. Cost-of-living or inflationary increases in subsequent budget years for recurring costs such as personnel and supplies may not exceed three percent escalation per year. Although the financial plans of the NINR provide support for this program, awards pursuant to this RFA are contingent upon the availability of funds and the receipt of a sufficient number of applications of outstanding scientific and technical merit. RESEARCH OBJECTIVES In FY 1994, the National Institute of Nursing Research implemented the research center core grant (P30) mechanism. This program has served as an important mechanism for building and maintaining intellectual and physical resources that serve as the infrastructure for synergism among researchers in a specific area of scientific inquiry. Centers promote programs of research related to NINR program areas, foster interdisciplinary research, and provide an important mechanism to support the delivery of research results into the clinical practice community. The success of the NRCC is greater when scientific and professional personnel representing a variety of disciplines are willing to relate to and collaborate with each other in order to facilitate the development of new knowledge. The promotion of interdisciplinary research is a valued component of the centers program. The core center program will provide funding for institutions at various developmental stages of nursing research capability. The field of nursing research has many institutions with nursing programs in earlier stages of establishing research programs. At the same time there are also institutions with well-developed nursing research programs and those that have new areas identified for future development. Programs at these different developmental stages may require different forms of core support. Applicants should select the scientific area of inquiry based on a conceptually sound integration of currently funded projects. The link to nursing practice issues within the center should be explicit. Applications should contain innovative ideas and sound methodology in a specific aspect of nursing research consistent with the NINR mission. The following NINR research program categories describe the broad areas of interest, proposed scientific areas for this RFA are not limited to the following concepts, however. o Research in chronic illness and long term care, including care of individuals with arthritis, diabetes, and urinary incontinence, and long-term care and caregiving. o Research in health promotion and risk behaviors, including studies of women"s health, developmental transitions, such as adolescence and menopause, environmental health, and health and behavior research, such as studies of exercise, nutrition, and smoking cessation. o Research in reproductive and infant health, including prevention of premature labor, reduction of health-risk factors during pregnancy, normal physiologic processes of labor and delivery, delivery of prenatal care, care of neonates, infant growth and development, and fertility issues. o Research in cardiopulmonary health and critical care, including prevention and care of individuals with cardiac or respiratory conditions. This area also includes research in critical care, trauma, wound healing, and organ transplantation. o Research in immune responses and oncology, including care of individuals experiencing symptoms primarily associated with cancer and AIDS, such as fatigue, nausea and vomiting, and cachexia. Prevention research on specific risk factors is also included. o Research in neurofunction and sensory conditions, including pain management, sleep disorders, and symptom management for persons with cognitive impairment or chronic neurological conditions. This area also includes research on patient care in acute care settings. Applicants from institutions that have a General Clinical Research Center (GCRC) funded by the NIH National Center for Research Resources may wish to identify the GCRC as a resource. Details of the interactions of the NRCC staff with the GCRC staff and research personnel may be provided in a statement describing the collaborative linkages being developed. A letter of agreement from the GCRC Program Director must be included with the application. SPECIAL REQUIREMENTS A nursing research center must be an identifiable organizational unit either within a college or school of nursing or within a department of nursing in a university-affiliated medical center or hospital or other similar entity. A Nursing Research Center Core Grant benefits from an interdisciplinary approach. When multiple organizations within an institution are represented in the application, clear lines of authority and sanction by the appropriate institutional officials must be specified. Funding is intended to support shared resources and facilities (core units) that will enhance and extend the effectiveness of research at the applicant institution. Cores A core is a shared central facility, such as a laboratory, service, or other resource. Each core is directed by an investigator with substantial expertise related to the core. Core facilities may be proposed which will enhance productivity or in other ways benefit a group of investigators to accomplish their stated goals. An important consideration is the degree to which core facilities will be utilized by and benefit individual ongoing-funded projects and center investigators and will assist in the development of the scientific area of inquiry. Each center must have a minimum of three core units. Administrative Core An Administrative core is mandatory for all NRCCs. The Administrative Core should manage the overall activities of the Center. This should include the following: 1. A specified Director and Associate Director, 2. A description of the administrative structure, 3. A general description of overall facilities and institutional commitment, 4. Separate budget pages detailing the various administrative expenses and the pilot and/or feasibility studies, if included in the administrative core. Each applicant institution will name an NRCC Director who will be the key figure in the administration and management of the NRCC grant. The Director will be responsible for the organization and operation of the NRCC. The Director should be experienced in conducting research and have demonstrated ability to coordinate, integrate, and provide guidance in the establishment of new programs in the scientific area of inquiry. The Director must make an appropriate time commitment. An Associate Director must be named who will be involved in the administrative and scientific efforts of the Center. It is expected that the NRCC administrative structure will accomplish the following: 1. coordinate and integrate the NRCC components and activities, 2. review the utilization of funds, including funds for pilot and feasibility studies, 3. advise the NRCC Director on the activities of the Center"s cores, Other Core Units The NINR, through the NRCC mechanism, may support cores that seem likely to result in scientific accomplishments. It is important to note that support is not allowed for cores that only replace or centralize resources supported on individual project grants. The other core units may be a combination of research support, research development, and research dissemination. Various types of other core units are acceptable. Examples of possible cores that may be proposed include: Statistical Support Core: Provides centralized research equipment and services as well as data management functions such as patient registry, patient coordination, evaluation, clinical and laboratory data gathering, biometry or statistical data coordination. Assistance from computer experts, biostatisticians, and other individuals who can assist or collaborate with the participating investigators in conducting laboratory or applied clinical research relevant to clinical practice and patient outcomes issues may also be desirable. Regional Centers: Provides a focal point that can increase the pool of nursing researchers and resources and allow them to be more efficiently managed in a specified area of research. Regional activities may be an effective method of increasing involvement of minority investigators and enhancing research on minority health issues. Biobehavioral or biomedical core: Provides a centralized laboratory, allowing the access to large scale equipment, specialized personnel, and other items necessary to conduct basic or applied research. Dissemination Core: Supports dissemination of research or other results in the selected topical area into clinical practice by facilitating the research training of staff in new skills and techniques as well as enhancing the exchange and dissemination of information critical to the scientific area of inquiry both within the NRCC and within the broader scientific community. Applications are not limited to these examples, additional research cores are welcomed. All cores must be well justified, conceptually linked to the scientific area of inquiry, clearly demonstrate how the shared resources will enable investigators to conduct their independently funded research projects more efficiently and/or more effectively, and remain within the $300,000 total costs of the NRCC award. In a Nursing Research Center Core Grant application, it is not sufficient for the applicant merely to identify such centralized resources. Rather, it must be demonstrated exactly how each core would augment or enhance the present capabilities of the investigators and make possible new activities. In addition, after an award is made, the NINR will require documentation in annual progress reports and in renewal applications that sharing of resources has been achieved. PILOT/FEASIBILITY STUDIES Pilot and/or feasibility studies are a mandatory component of the NRCC application. These are intended to enable eligible investigators to explore the feasibility of a concept within the scientific area of inquiry and to amass sufficient data to pursue it through other funding mechanisms. They may be included in any proposed core, including the Administrative Core. The monies provide modest research support for a limited time (one (1) year or two (2) years maximum with clear justification for the time length). Eligible investigators include: 1. An established investigator in the scientific area of inquiry with a proposal for testing the feasibility of a new or innovative idea that is conceptually related but represents a clear and distinct departure from the investigator"s ongoing research interest, 2. An established, supported investigator with no previous work in the scientific area of inquiry who is willing to test the applicability of his/her expertise on a conceptually related problem, 3. A new investigator who has not been a Principal Investigator in the past, or who is not currently funded with an NIH research project grant (e.g., R01, P01, R29). Applications must propose at least three pilot and/or feasibility studies to be carried out during the first year. Standard guidelines for IRB approval apply. The theoretical basis for the pilot and/or feasibility studies must be clearly explicated for the behavioral, psychosocial, and/or biological strategies being used. An interdisciplinary approach should be utilized to promote the collaboration of nurse scientists with scientists of other disciplines. Each pilot and/or feasibility study is limited to fifteen pages of description for the Research Plan, Sections a through d, and should delineate the question being asked, detail the procedures to be followed, and discuss how the data will be analyzed. Subsequent pilot and/or feasibility studies (a minimum of two (2) ongoing each year) will be developed during the course of the award. A description of how the pilot and/or feasibility studies will be reviewed and selected must be provided. Results of each pilot and/or feasibility study must be in the Center"s annual progress reports to the NINR along with the plan used to solicit the new pilot and/or feasibility studies. For pilot and/or feasibility studies involving clinical research, NIH requires applicants to give special attention to the inclusion of women, minorities and children in study populations. Study populations must be described in the research design and methods section for each pilot and/or feasibility study. If women, minorities or children are not included in the study populations for the clinical studies, a specific justification for each of these exclusions must be provided. Applications without such documentation will not be accepted for review. Further information about this policy may be requested from NINR staff. ADMINISTRATIVE STRUCTURE OF THE NRCC While the final administrative structure of the NRCC will, for the most part, be left to the discretion of the applicant institution, NIH"s experience has demonstrated that the effective development of Center programs requires interaction among the Director, the core leaders, the Principal Investigators of research projects using the cores, appropriate institutional administrative personnel and the staff of the awarding agency. To facilitate communication between the NRCC staffs and the NINR, the NINR expects that each NRCC application will include funds for the NRCC Director, Associate Director, and business official to travel to an annual meeting in Bethesda, Maryland. An Executive Committee, consisting of the Associate Director and the heads of each of the cores and the business official, should be established to assist the Director in making the scientific and administrative decisions relating to the Center. In addition to coordination of the NRCC, the Director, with his or her Executive Committee, will be responsible for allocation of NRCC funds, the identification and selection of key personnel, and the planning and evaluation of the NRCC activities. An external Advisory Committee should be established and composed of scientists from within the institution and at least two (2) scientists from outside the institution. This committee may also be used in evaluating the overall research programs of the NRCC, the effectiveness of communications within the NRCC, and any other activities in which problems arise for which expertise is required or desirable. The advisory committee should meet at least once annually. However, the nature of its responsibilities may require ad hoc meetings at more frequent intervals. A member of the NINR extramural program staff is to be invited to attend each meeting as an observer. The NRCC Director must describe the process that he or she will use to review the pilot and/or feasibility studies for future years of the proposed center. The review process may be carried out by the Advisory Committee, by an ad hoc Review Committee, by a mail review, or by a combination of these methods. It is recommended that the NRCC Director utilize at least two (2) scientists with expertise relevant to the scientific area of inquiry of the NRCC from outside the institution during the review process. The complex nature of administrative requirements of the NRCC will necessitate the assistance of a person with business management expertise. It is important that such an official be identified and directly involved with the fiscal aspects of the NRCC application and grant. An appropriate amount of this individual"s time and effort should be committed for this purpose. The institutional business official should be a member of the Executive Committee. While budget formulation and planning will undoubtedly begin with the Director in collaboration with the scientific staff, the business official should be involved in the process and provide consultation in matters of fiscal administration and evaluate such issues as equipment on hand versus that requested for the core facilities. The business official should attend the annual Director"s meeting and funds may be requested in the budget for this purpose. EVALUATION PLAN A plan for evaluating progress toward aims and/or goals of each core and the overall NRCC is required. This plan should include the specific criteria and methods that will be used for the evaluation. The plan should specify the types of evaluation information that will be submitted in the center’s annual progress reports. Annual progress reports of a funded NRCC will be reviewed by NINR staff. 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 subpopulations must be included in all NIH-supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided 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). Investigators proposing research involving human subjects should read the NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research which were published in the Federal Register of March 28, 1994 (FR 59 14508- 14513), and in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators may obtain copies from these sources or from the program staff or contact person listed under Inquires section. Program staff may also provide additional relevant information concerning the policy. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (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 should read "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: http://grants.nih.gov/grants/guide/notice-files/not98-024.html LETTER OF INTENT Prospective applicants are asked to submit, by December 14, 1998, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of this RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NINR staff to estimate the potential review workload and to avoid conflict of interest in the review. The letter of intent is to be sent to: Robin L. Gruber, MPS National Institute of Nursing Research Building 45, Room 3AN-12 Bethesda, MD 20892-6300 Telephone: (301) 594-2736 or 6906 FAX: (301) 480-8260 Email: robin_gruber@nih.gov APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 5/95) is to be used to apply for these grants. These forms are available at most institutional offices of sponsored research and from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email: GrantsInfo@nih.gov. Sample tables and additional information on the application format and contents are outlined in the NRCC application guidelines available upon request from 301/594-6906. Page Limitations: Each core is limited to 25 pages and each pilot study is limited to 15 pages for the Research Plan sections a through d. Lesser numbers of pages are acceptable. Budget: A separate budget page, with appropriate justification pages, is required for each core and pilot study. The RFA label available in the PHS 398 (rev. 5/95) application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed in line 2 of the face page of the application form and the YES box must be marked. Submit a signed, typewritten original of the application, including the Checklist, and three signed, photocopies, in one (1) package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must also be sent to: Dr. Mary Stephens-Frazier Division of Extramural Activities National Institute of Nursing Research Building 45, Room 3AN-12 MSC 6300 Bethesda, MD 20892-6300 Telephone: (301) 594-6906 Applications must be received by the application receipt date listed in the heading of this RFA. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by NINR. Incomplete and/or non-responsive applications will be returned to the applicant without further consideration. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NINR in accordance with the review criteria stated below. As part of the initial merit review, all applications will receive a written critique and may undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed, assigned a priority score, and receive a second level review by the National Advisory Nursing Council. Review Criteria The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments reviewers will be asked to discuss the following aspects of the application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered in assigning the overall score, weighting them as appropriate for each application Careful consideration of the information in the SPECIAL REQUIREMENTS section of the RFA and the following review criteria will be used to evaluate the NRCC grant (P30) applications: RESEARCH BASE 1. Focus and depth of funded investigations that are currently in progress. 2. Presence of current and emerging collaborations and interactions, with common research interests, among the investigators within the research base. 3. Impact that funded investigators have made in their respective fields, as indicated by publications and other factors. 4. The qualifications, experience, and commitment of the NRCC investigators responsible for the individual research projects, and their willingness to interact with each other. 5. The appropriateness of the investigators as participants of the center, and whether their activities warrant core support. INDIVIDUAL CORE PROJECTS 1. The inclusion of a mandatory Administrative core to manage the overall activities of the Center. 2. The appropriateness and relevance of the proposed cores and the modes of operation, facilities, and potential for contribution to ongoing nursing research. 3. Evidence of collaborative and/or interdisciplinary research. 4. Appropriate justification for each core component. Considerations include the duplication of existing resources or services and anticipated future use of each core. PILOT AND/OR FEASIBILITY STUDIES 1. The scientific merit of the research proposed, how well the research fits into the focus of the overall center grant and the importance of the information sought to the goals of the NINR. 2. The feasibility and promise of the proposed methods. 3. The novelty or originality of the applications. 4. The training, experience, and research competence of the investigator(s). 5. The suitability of the facilities for the proposed research, including the availability of required special resources. 6. The appropriateness and justification of the requested budget for the proposed work. 7. Provisions for the protection of human subjects and the humane care of animals. OVERALL CENTER CORE GRANT APPLICATION 1. The overall scientific merit and the potential of the research program for making a significant contribution to achieving the goals of the NINR. 2. The scientific gain from linking the research projects in a center grant, i.e., the degree of interrelatedness and synergism among the components of the center. 3. An interdisciplinary approach. 4. The qualifications of the Principal Investigator and other key investigators and the commitment of participating investigators to a common goal and to collaboration. 5. The adequacy of the available resources and the quality of the research environment. 6. The adequacy of the multiple aspects related to the administrative structure for the center, including the ability of the center director to provide the scientific and administrative leadership for the project, strategies to promote scientific planning, interaction, implementation, and evaluation, and arrangements for the fiscal management of the grant. 7. The institutional commitment to the center in terms of space, resources, administrative authority, and other necessary support, the extent to which the center is recognized as a major element within the organizational structure of the institution. 8. The plans for developmental activities, including recruitment and expansion, insofar as these are justified by the proposed research program. 9. The plans for outreach and collaboration with other groups doing related work. 10. Provisions for the protection of human subjects and the humane care of animals. A plan for evaluation of activities of the NRCC. 12. Appropriateness of the requested budget for the work proposed. 13. Proposed composition and functions of the external advisory committee Proposed process of reviewing pilot/feasibility studies In addition to the above criteria, in accordance with NIH policy, all applications will also be reviewed with respect to the following: o The adequacy of plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. o The reasonableness of the proposed budget and duration in relation to the proposed research. o The adequacy of the proposed protection for humans, animals or the environment, to the extent they may be adversely affected by the project proposed in the application. The initial review group will also examine the provisions for the protection of human subjects and the safety of the research environment. Schedule Letter of Intent Receipt Date: December 14, 1998 Application Receipt Date: January 14, 1999 Peer Review Date: March 1999 Council Review: May 1999 Earliest Anticipated Start Date: July 1999 AWARD CRITERIA Award criteria that will be used to make award decisions include: o scientific merit (as determined by peer review) o availability of funds o programmatic priorities. INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. NRCC application guidelines are available upon request from NINR staff. Direct inquiries regarding programmatic/scientific issues to: Cara J. Krulewitch, CNM, PhD Division of Extramural Activities National Institute of Nursing Research Building 45, Room 3AN-12 MSC 6300 Bethesda, MD 20892-6300 Telephone: (301) 594-2542 FAX: (301) 480-8260 Email: cara_krulewitch@nih.gov Direct inquiries regarding fiscal matters to: Jeff Carow Grants and Contracts Management Office National Institute of Nursing Research Building 45, 3AN-12 MSC 6301 Bethesda, MD 20892 Telephone: (301) 594-6869 FAX: (301) 480-8260 Email: jeff_carow@nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.361 Nursing Research. Awards will be made under the authority of the Public Health Service Act, Title IV, Part A (Public Law 78- 410, as amended by Public Health Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies and Federal regulations 42 CFR Part 52 and 45 CFR Part 74. This program is not subject to intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant 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, any 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.


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