EXPIRED
COMMUNITY-PARTNERED INTERVENTIONS TO REDUCE HEALTH DISPARITIES RELEASE DATE: July 24, 2002 PA NUMBER: PA-02-134 EXPIRATION DATE: June 14, 2005, unless reissued. National Institute of Nursing Research (NINR) (www.nih.gov/ninr) THIS PA CONTAINS THE FOLLOWING INFORMATION o Purpose of the PA o Research Objectives o Mechanism(s) of Support o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Where to Send Inquiries o Submitting an Application o Peer Review Process o Review Criteria o Award Criteria o Required Federal Citations PURPOSE OF THIS PA The National Institute of Nursing Research (NINR) invites applications for community-partnered interventions to reduce health disparities in racial and ethnically diverse minority populations. Specifically, this announcement seeks applications with a focus of reducing health disparities through demonstrated partnerships with the target community(ies) throughout all phases of the research process. For purposes of this announcement, community-partnered interventions are defined as interventions in which the investigator(s) establishes a research partnership with members of the target community throughout all phases of the research process. Consistent with the tenets of participatory research, inclusion is a critical component for building and sustaining community partnerships in research. Full participation and engagement of the targeted community must be accomplished throughout the research process. Thus the research partnership begins with the identification of the research focus and continues throughout the dissemination and follow-up phases related to the research. RESEARCH OBJECTIVES Since the release of the landmark document, the Secretary's Task Force report on Black and Minority Health in 1986, numerous initiatives have been implemented to address the ongoing health disparities noted among racial and ethnically diverse minority populations. Specific conditions, namely cardiovascular disease, cancer, infant mortality, diabetes, lack of immunization, and HIV/AIDS, affect racial and ethnically diverse minority communities at rates several times higher than the national averages. For example, in 1988, the age-adjusted death rate for coronary heart disease among non-Hispanic black people was 40% higher than the rate for non-Hispanic whites, 136.3 per 100,000 population vs. 95.1 per 100,000 population respectively. The fact that Native Americans have the poorest five-year survival for all cancers combined when compared to other populations provides yet another example of the disparities in health among racial and ethnically diverse minority populations. Despite the numerous initiatives and interventions targeting these populations, the disparities in health remain. The goal of eliminating health disparities has received considerable national attention in recent years. In concert with the national emphasis on eliminating health disparities, NINR along with other Institutes and Centers at the National Institutes of Health (NIH) have outlined their respective objectives and strategic plans related to reducing/eliminating health disparities. The NIH strategic plan on reducing health disparities is located at http://healthdisparities.nih.gov/working.html. NINR's strategic plan on reducing health disparities is located at http://www.ninr.nih.gov. This initiative places an emphasis on reducing health disparities through establishing and sustaining community partnerships during the research process. Definitions related to health disparities and health disparity populations are outlined in the National Institutes of Health's Comprehensive Plan to Reduce or Eliminate Health Disparities, and are used for purposes of this solicitation. Health disparity research is basic, clinical, and behavioral studies on health conditions that are unique to, more serious, or more prevalent in subpopulations that are economically disadvantaged and medically underserved [and confirmed by the Agency for Healthcare Research and Quality as "health disparity groups"]. A health disparity population is defined as one where a documented, and significant disparity has been identified in the overall rate of disease incidence, morbidity, mortality, and survival rates in the population as compared to the health status of the general population. Minority population refers to racial and ethnic minority groups which usually include African Americans, Hispanics, Native Americans, Alaska Natives, Hawaiian Islanders, Asian and Pacific Islanders. Accordingly, these groups will be the target populations for this announcement. In 1986, the disparities in health status and health outcomes among minority populations were identified in the Secretary's Task Force on Black and Minority Health (1). Since the release of this landmark document in 1986, numerous initiatives have been implemented to address the ongoing disparities noted among racial and ethnic minority populations. Special objectives and activities targeting racial and ethnic minority populations have been outlined in Healthy People 2000 (2), the Health and Human Services Initiative to Eliminate Racial and Ethnic Disparities in Health (3), and, most recently Healthy People 2010 (4). Similar to Healthy People 2010, Healthy People 2000 included over 200 special population subobjectives related to addressing health disparities in special populations at higher risk than the total population for death, disease, or disability. Although much remains to be done, data from the Healthy People 2000 Final Review show progress in reducing health disparities in some areas. For example the American Indian Alaska Native population demonstrated improvements in hepatitis and bacterial meningitis, and Asian Pacific Islanders showed a reduction in such important areas as cigarette smoking. Disparities also narrowed for African-Americans in such categories as cancer deaths, firearm related deaths, unintentional injuries, clinical breast examination, mammography and syphilis. Data for Hispanic persons indicated a reduction in disparities related to infant mortality, and use of clinical breast exam and mammography (5). However, despite numerous initiatives, racial and ethnic minorities continue to experience poorer health and poorer health outcomes when compared to their white counterparts. For example, African-American men are 26% more likely than white men and almost twice as likely than Hispanic men to die from heart disease. They also are more likely to die of heart disease before age 65. Diabetes constitutes the leading cause of death among American Indians. Black and Hispanic women accounted for 81% of AIDS cases from July 1999 to June 2000 (6). The fact that Native Americans have the poorest five-year survival for all cancers combined when compared with other populations provides yet another example of the disparities (7). The disparity in disease incidence, mortality, and morbidity is even more striking among socioeconomically disadvantaged individuals. This is particularly important given the disproportionate number of racial and ethnic minorities that are socioeconomically disadvantaged. Progress in successfully addressing health disparities will be greatly facilitated by ongoing efforts within the NIH and other initiatives and priorities outlined by the Department of Health and Human Services. While much has been gleaned from previous research with racial ethnic populations, ongoing research is needed to provide direction for improving standards of care, informing public policy, and identifying strategies aimed at improving the health status and health outcomes of racial and ethnic minorities. The need to further enhance our knowledge and understanding of the numerous and complex factors (i.e., socioeconomic, cultural, societal, behavioral and biologic aspects of health) that influence the health status of racial and ethnic minority populations across the lifespan is important. The projected growth in minority populations further underscores the need to examine health disparities. Community partnered interventions devoted to reducing health disparities are particularly needed because of their potential to: 1) build on existing community resources, knowledge, skill, and attributes; 2) engage community members in actively identifying and addressing key health issues or concerns; 3) facilitate the building of trusting relationships between the research community and target population; and 4) enhance the likelihood of long-term sustainability and follow-up. Additional benefits associated with a partnered approach in research include: 1) enhancing the validity and quality of the research by incorporating the knowledge of the people involved; 2) bridging "cultural gaps" that may exist between the partners involved; 3) incorporating cultural, social, and economic factors that may influence health; and 4) facilitating the design of culturally appropriate, sensitive, and linguistically appropriate measures and methods as well as 5) providing resources and opportunities for the involved community. Challenges associated with conducting community-partnered interventions can include: difficulties maintaining trust and sustainability while preserving scientific integrity, time consuming goals and activities, and lack of skill and resources related to successfully conducting an intervention. While the purpose of this initiative is to stimulate research utilizing community-partnered research interventions to reduce health disparities, preliminary studies that will lead to such studies are encouraged if such work is essential to achieve the overall purpose(s). This may be particularly needed in research on less studied populations. For example, while some studies have focused on racial and ethnic minority populations, there is a need for additional studies that focus on minority populations and their subpopulations. To illustrate, while there is a growing body of research on the breast cancer screening among Hispanic women in general, there are fewer studies focusing on Hispanic subpopulations (e.g., Puerto Rican, Mexican American). Federally Qualified Health Centers (FQHCs) may provide a valuable resource to applicants interested in responding to this PA, particularly those that have an active collaboration with colleges and universities. These FQHCs include Community Health Centers and Migrant Health Centers across the country. Information may be found at the DHHS Health Resources and Services Administration website for the Bureau of Primary Health Care: http://pubs.niaaa.nih.gov/publications/datasys.htm An executive summary of a recent NINR sponsored workshop, titled "Community- Partnered Interventions in Nursing Research to Reduce Health Disparities" may be found at www.nih.gov/ninr/news-info/publications.html. References 1. U.S. Department of Health and Human Services. Report of the Secretary's task force on black and minority health. Vol. 1. Executive Summary. Washington, DC: U. S. Government Printing Office, 1986. 2. U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Department of Health and Human Services Publication No. (PHS) 91-5050212. Washington, DC: U.S. Government Printing Office, 1993. 3. U.S. Department of Health and Human Services. HHS reshaping of minority communities and underserved populations [Online] http://www.hhs.gov/news/press/2001pres/01fsminhlth.html 2001. 4. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and improving health (second edition) Superintendent of Documents Stock No. 017-001-00550-9, 2000. 5. U.S. Department of Health and Human Services. Health People 2000 Final Review. Washington, DC: U.S. Government Printing Office, 2001. 6. U.S. Department of Health and Human Services. Achieving new milestones in minority health. [Online] http://www.hhs.gov/news/press/2001pres/01fsminorityhealth.html 2001. 7. American Cancer Society. Cancer facts and figures. Atlanta, GA: Author, 2000. Potential Research Areas The following are potential areas of research related to this program announcement. These examples are not listed in any priority order and are not to be viewed as an exhaustive or exclusive listing of potential areas. Given the need for community involvement in identifying the research focus, the following represent broad topical areas that have been identified as potential areas of inquiry: o Development and testing of culturally relevant measures of clinical and cost outcomes of community-partnered interventions aimed at reducing health disparities. o Intervention studies designed to reduce risk factors and risk exposures that contribute to the six disparity areas of cardiovascular disease, diabetes, HIV/AIDS, cancer screening and management, infant mortality, and immunization. o Intervention studies to enhance health seeking and health maintenance behaviors that incorporate the sociocultural attributes and cultural strengths of racial and ethnic minority populations and their subpopulations. o Intervention studies devoted to preventing, reducing, or ameliorating health behaviors associated with the nine major contributors of mortality in the United States (e.g., tobacco use, diet and activity patterns, alcohol use, microbial agents, toxic agents, firearm use, sexual behavior, motor vehicle accidents, and illicit drug use) among racial ethnic minority populations. o Evaluation of existing community-partnered interventions for their impact, effectiveness, and efficiency in reducing health disparities. o Innovative intervention studies using technology to monitor and/ or facilitate the management of chronic illness among racial ethnic minority populations. o Intervention studies that address the excess cancer burden noted among racial and ethnic minority populations. o Intervention studies using culturally appropriate strategies to address the high incidence of diabetes in Native American populations. MECHANISMS OF SUPPORT This PA will use the NIH R01 and R21 award mechanisms. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project. The objective of the exploratory/developmental mechanism (R21) is to encourage applications from individuals who are interested in testing innovative or conceptually creative ideas that are scientifically sound and may advance our understanding of community partnered interventions. Investigators are encouraged to explore the feasibility of an innovative research question or approach that will provide a basis for future research project applications. Exploratory/developmental grants (R21) are limited to 2 years of support and up to $150,000 per year in direct costs. This PA uses just-in-time concepts. It also uses the modular budgeting format. (see http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if you are submitting an application with direct costs in each year of $250,000 or less, use the modular format. ELIGIBLE INSTITUTIONS You may submit (an) application(s) if your institution has any of the following characteristics: o For-profit or non-profit organizations o Public or private institutions, such as universities, colleges, hospitals, and laboratories o Units of State and local governments o Eligible agencies of the Federal government o Domestic or foreign o Faith-based institutions and tribal nations o Community-based organizations INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH programs WHERE TO SEND INQUIRIES We encourage your inquiries concerning this PA and welcome the opportunity to answer questions from potential applicants. Inquiries may fall into two areas: scientific/research and financial or grants management issues: o Direct your questions about scientific/research/review issues to: Dr. Janice Phillips Office of Extramural Programs National Institute of Nursing Research 6701 Democracy Blvd, Room 710, MSC 4870 Bethesda, MD 20892-4870 Telephone: (301) 594-6152 FAX: (301) 480-8260 Email: [email protected] o Direct your questions about financial or grants management matters to: Ms. Sally York Office of Grants and Contracts Management National Institute of Nursing Research 6701 Democracy Blvd, Room 710, MSC 4870 Bethesda, MD 20892-4870 Telephone: (301) 594-2154 FAX: (301) 480-8260 Email: [email protected] SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 710-0267, Email: [email protected]. Please note, when completing an application for the R21 mechanism, Items a-d in the Research Plan must not exceed a total of 15 pages. Tables and figures are included in the page limitations. Applications that exceed the page limitation or NIH requirements for type size and margins (refer to PHS 398 application for details) will be returned to the applicant without further consideration. The 15-page limitation does not include Items e-i (Human Subjects, Vertebrate Animals, Literature Cited, Consortia and Consultants/Collaborators). APPLICATION RECEIPT DATES: Applications submitted in response to this program announcement will be accepted at the standard application deadlines, which are available at http://grants.nih.gov/grants/dates.htm. Application deadlines are also indicated in the PHS 398 application kit. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting up to $250,000 per year in direct costs must be submitted in a modular grant format. The modular grant format simplifies the preparation of the budget in these applications by limiting the level of budgetary detail. Applicants request direct costs in $25,000 modules. Section C of the research grant application instructions for the PHS 398 (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step guidance for preparing modular grants. Additional information on modular grants is available at http://grants.nih.gov/grants/funding/modular/modular.htm. SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: Applications requesting $500,000 or more in direct costs for any year must include a cover letter identifying the NIH staff member within one of NIH institutes or centers who has agreed to accept assignment of the application. Applicants requesting more than $500,000 must carry out the following steps: 1) Contact the IC program staff at least 6 weeks before submitting the application, i.e., as you are developing plans for the study; 2) Obtain agreement from the IC staff that the IC will accept your application for consideration for award; and, 3) Identify, in a cover letter sent with the application, the staff member and IC who agreed to accept assignment of the application. This policy applies to all investigator-initiated new (type 1), competing continuation (type 2), competing supplement, or any amended or revised version of these grant application types. Additional information on this policy is available in the NIH Guide for Grants and Contracts, October 19, 2001 at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. In addition to the research plan and related timelines, applicants responding to this announcement MUST include the following: o Identification of the target community, selected health disparity topic and rationale(s)for these choices. Health disparity topics should focus on a specific health problem vs. a health care delivery issue. Topics such as the excess cancer burden in racial/ethnic minority populations, the high incidence of diabetes in Native Americans, or the excess death rate from cardiovascular disease among African Americans, to name a few. o Evidence of an existing community partnership or plans for establishing and sustaining a partnership with the target community in the form of letters of agreement to participate. o A plan for sustaining the partnership in the community after completion of the grant. o Information related to the research partnership between the target community and the research team. For example, --How will key members of the target community be involved throughout all phases of the research process? --How will the research team facilitate a collaborative relationship and sustain equitable involvement throughout the research project? --What are some potential mutual benefits to the community and the research team? --How will the strengths and resources of the community be utilized to enhance the community partnership? --What are some suggested plans for disseminating the research findings to the target community? --What are some opportunities and strategies for use by the target community to enhance their health and well being as well as reduce the health disparity topic? SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the checklist, and five signed photocopies in one 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) APPLICATION PROCESSING: Applications must be received by or mailed on or before the receipt dates described at http://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR will not accept any application in response to this PA 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 a substantial revision of an application already reviewed, but such application must include an Introduction addressing the previous critique. PEER REVIEW PROCESS Applications submitted for this PA will be assigned on the basis of established PHS referral guidelines. An appropriate scientific review group convened in accordance with the standard NIH peer review procedures (http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific and technical merit. As part of the initial merit review, all applications will: o Receive a written critique o Undergo a selection process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed and assigned a priority score o Receive a second level review by the appropriate national advisory council or board 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 your application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals: o Significance o Approach o Innovation o Investigator o Environment The scientific review group will address and consider each of these criteria in assigning your application's overall score, weighting them as appropriate for each application. Your application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, you may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) SIGNIFICANCE: Does your study address an important problem? If the aims of your application are achieved, how do they advance scientific knowledge? What will be the effect of these studies on the concepts or methods that drive this field? (2) APPROACH: Are the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Do you acknowledge potential problem areas and consider alternative tactics? (3) INNOVATION: Does your project employ novel concepts, approaches or methods? Are the aims original and innovative? Does your project challenge existing paradigms or develop new methodologies or technologies? (4) INVESTIGATOR: Are you appropriately trained and well suited to carry out this work? Is the work proposed appropriate to your experience level as the principal investigator and to that of other researchers (if any)? (5) ENVIRONMENT: Does the scientific environment in which your work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application will also be reviewed with respect to the following: PROTECTIONS: 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. INCLUSION: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria included in the section on Federal Citations, below) DATA SHARING: The adequacy of the proposed plan to share data. BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. AWARD CRITERIA Applications submitted in response to a PA will compete for available funds with all other recommended applications. The following will be considered in making funding decisions: o Scientific merit of the proposed project as determined by peer review o Availability of funds o Relevance to program priorities REQUIRED FEDERAL CITATIONS MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components involving Phase I and II clinical trials must include provisions for assessment of patient eligibility and status, rigorous data management, quality assurance, and auditing procedures. In addition, it is NIH policy that all clinical trials require data and safety monitoring, with the method and degree of monitoring being commensurate with the risks (NIH Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html). INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: 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 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at http://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: The NIH maintains a policy 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 should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at http://grants.nih.gov/grants/funding/children/children.htm. 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. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. 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 http://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 an 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. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. 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 PA 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. AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance No. 93.361, and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. 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 described at http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. The PHS strongly encourages all grant recipients to provide a smoke-free workplace and discourage the 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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