IMPLEMENTATION OF INTERVENTION STRATEGIES FOR CHILDREN WITH DISRUPTIVE BEHAVIORS

Release Date:  January 18, 2000

RFA:  MH-00-011

National Institute of Mental Health

Letter of Intent Receipt Date:  May 15, 2000
Application Receipt Date:       June 13, 2000

THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS.  THIS RFA INCLUDES 
DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED 
WHEN PREPARING AN APPLICATION IN RESPONSE TO THIS RFA.

PURPOSE

The National Institute of Mental Health (NIMH) invites research grant 
applications to examine the implementation of prevention strategies in real 
world settings for disruptive behavior disorders in children and adolescents.  
Practice settings include schools, pediatric healthcare settings, mental health 
clinics, foster care settings, detention facilities, to name just a few.  The 
purpose of this initiative is to foster studies of implementation approaches, 
barriers to and facilitators of implementation, and cost-effectiveness of tested 
preventive programs or strategies, with a focus on elucidating those elements of 
implementation that are necessary for sustaining preventive approaches within 
diverse real-world settings.

Disruptive behavior disorders comprise a host of syndromes, typically including 
ADHD, oppositional defiant disorders, and conduct disorders.  Together these 
disorders represent costly public health problems.  Children and adolescents 
with these disorders often have co-occurring symptoms, such as depression or 
anxiety, and may display severe impairments in many domains of functioning.  
These impairments can lead to long-term adverse consequences, such as diminished 
academic performance, vocational limitations, and difficulties in social and 
emotional development.

The purpose of this RFA is to encourage research applications that extend the 
evidence base on preventive interventions by taking them to a new level.  That 
is, this RFA encourages studies of (a) implementation, replication, and 
deployment strategies for sustaining prevention programs targeted towards 
reducing risks for or the onset of disruptive behavior problems; and (b) key 
factors associated with successful implementation of or barriers to 
implementation in multiple practice settings.

Since approaches to intervening with children typically involve multiple 
gateways or points of contact (e.g., parents/caregivers, teachers, 
pediatricians, etc), applications are encouraged from a wide range of 
disciplines and efforts to involve key stakeholders in different systems are 
especially encouraged.  While a range of efficacious strategies for ameliorating 
disruptive behavior problems have been developed in the past decade, no 
concerted attention has yet been paid to replication of these strategies in 
ethnically-diverse communities nor to implementation approaches to ensure 
sustainability of preventive services within communities.  Studies addressing 
these issues are encouraged.

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), 
Implementation of Intervention Strategies for Children with Disruptive Disorders 
is related to the priority area of Mental Health and Mental Disorders.  
Potential applicants may obtain a copy of "Healthy People 2000" at 
http://odphp.osophs.dhhs.gov/pubs/hp2000/

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and non-profit 
organizations, public and private, such as universities, colleges, hospitals, 
laboratories, units of State and local governments, and eligible agencies of the 
Federal government.  Racial/ethnic minority individuals, women, and persons with 
disabilities are encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research project grant 
(R01) and the Collaborative R01s for Clinical Studies of Mental Disorders award 
mechanisms.  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.  Future unsolicited competing continuation 
applications will compete with all investigator-initiated applications and be 
reviewed according to the customary peer review procedures.  The anticipated 
award date is September 29, 2000.

For all competing R01 applications requesting up to $250,000 direct costs per 
year, specific application instructions have been modified to reflect “MODULAR 
GRANT” and “JUST-IN-TIME” streamlining efforts being undertaken at NIH.  More 
detailed information about modular grant applications, including a sample budget 
narrative justification pages and a sample biographical sketch, is available via 
the Internet at: http://grants.nih.gov/grants/funding/modular/modular.htm.  
Applications that request more than $250,000 in any year must use the standard 
PHS 398 (rev. 4/98) application instructions.

Applicants interested in applying for Collaborative R01 award are strongly 
encouraged to consult with program staff (listed under INQUIRIES) and to obtain 
appropriate additional information concerning the program.  PAR-98-017,  
“Collaborative R01s for Clinical Studies of Mental Disorders, is available at 
http://grants.nih.gov/grants/guide/pa-files/PAR-98-017.html 

FUNDS AVAILABLE

The NIMH intends to commit approximately $1,500,000 in FY 2000 to fund 4 to 6 
new and/or competitive continuation grants in response to this RFA.  An 
applicant may request a project period of up to five years.  Because the nature 
and scope of the research proposed may vary, it is anticipated that the size of 
each award will also vary.  It is expected that the direct costs will be awarded 
in modules of $25,000; however, program and grants management adjustments may be 
necessary prior to award.  Although the financial plans of the Institute 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

Background

A robust body of research emanating from psychology, the behavioral sciences, 
epidemiology, education, and psychiatry has yielded over the past decade an 
impressive literature on risk factors for the development of disruptive behavior 
problems in children and adolescents.  This research has produced a wealth of 
descriptive information about the causes and consequences of disruptive behavior 
problems, and has identified a range of preventive strategies for ameliorating 
these problems.  A general consensus now exists concerning the characteristics 
of children, their families, and environments that are associated with the 
development of disruptive behavior problems, the more persistent and challenging 
nature of those syndromes that emerge in early childhood, and the clinical and 
public health importance of focusing prevention efforts on this group.

There is increasing awareness that many risks influence children early in life, 
through events such as child abuse or neglect, and that early onset of 
antisocial propensities may be a key variable leading to the development of 
later disruptive behavior problems.  The risks for older children are no less 
potent but involve socializing influences of deviant peers, harsh or punitive 
parenting approaches, and the pernicious influence of negative environments.  
Furthermore, it is now known that many children with disruptive behavior 
problems experience pronounced difficulties and impairments across multiple 
settings (home, school, and with peers).  Children with these symptoms often 
experience long-term adverse effects on academic performance, vocational 
success, and socio-emotional development.  In addition, these children are at 
increased risk for oppositional behavior, antisocial behavior, conduct problems 
and/or violence, and are overly represented in the justice system.

Over the past decade, prevention science has harnessed research on risk factors 
to develop a range of strategies for reducing risks associated with disruptive 
problems of youth and for offsetting these risks by promoting positive behaviors 
and skills.  However few of these programs are in widespread use at the local 
level.  Communities are eager to apply effective programming but recognize that 
there are numerous barriers to implementing research based models in local 
community settings.

Some of the approaches that have been developed to target precursors of these 
problems include home-based programs, school-based intervention models, and 
outreach programs through, for example, cooperative extension services. For 
example, a range of social skills programs, coping strategies, parent training 
and education, mentoring, and family support programs exist that target 
reduction in risks associated with the development of disruptive behavior 
problems.  However, to date, no concerted efforts have been made to take such 
preventive strategies, services or programs to their logical limit:  to test 
their implementation and deployment in multiple practice settings, including 
pediatric health care settings, and to identify factors that are critical for 
the uptake, sustainability, and longevity of these programs over time.

The purpose of this RFA is to study implementation practices, barriers to 
implementation, costs, organizational or environmental factors related to 
implementation, and replication of prevention programs for diverse ethnic 
populations. Implementation practices refer to a range of approaches for 
sustaining promising programs, such as dosage effects, training issues, 
organizational culture and climate, and fidelity of program implementation. 
Barriers to effective implementation include such factors as accessibility of 
program for its intended audience, ethnic or cultural perspectives that limit 
access, and organizational or structural/administrative barriers that restrict 
access.  Because the costs of implementing preventive programs are an important 
aspect of its ultimate disseminability, studies of the cost effectiveness or 
implementation costs are needed.  Factors related to community, healthcare, 
school, or other organizational environments that are hypothesized to be 
important to the successful implementation of preventive strategies need to be 
studied.  Finally, because there are special issues related to the replication 
of preventive strategies, services, or programs in different ethnic groups, such 
replication studies are strongly encouraged under this RFA.

Information on service use and patterns of care indicate that the majority of 
children with disruptive behavior problems who receive any services receive them 
in schools. Teachers use a variety of interventions in the classroom including 
changing seat arrangement, behavior modification, shortened assignments, peer 
tutoring, parent/teacher daily report cards, and frequent breaks; however, the 
generalizability of these interventions across school districts or counties, the 
factors that mediate their sustainability in different contexts, and the cost 
effectiveness of them have not been studied.  Available research on classroom 
behavioral interventions are composed largely of single-subject designs with 
limited generalizability.  In addition, other more broadly implemented school-
based interventions such as social or cognitive skills training need to be 
systematically evaluated for their replicability across systems. Strategies and 
programs such as parent management and classroom-based behavioral techniques, to 
name a few, have been found to improve outcomes for children with disruptive 
behavior disorders and their families.  The broader implementation and diffusion 
of these approaches into different community settings will require attention to 
implementation practices (e.g., training, dosage, fidelity), as well as barriers 
to implementation and the process of service access.

Data on implementation of programs in pediatric health care settings is very 
limited.  While the second most frequent setting in which children with these 
problems are seen is pediatricians’ offices, very little attention has been 
focused on implementing preventive strategies within health care settings.  
Pediatricians may be among the first to see children who are at risk for 
developing disruptive behavior problems.  Models for the implementation and 
evaluation of preventive interventions in the primary care setting are needed.

With this RFA, NIMH is encouraging researchers to collaborate with service 
providers (teachers, pediatricians, day care professionals, etc.) to study the 
implementation and deployment of preventive strategies for children with 
disruptive behaviors.  It is likely that this collaboration will stem from 
existing relationships or the evaluation of pre-existing interventions within 
these diverse settings.  Interdisciplinary interventions are particularly 
encouraged.

Listed below are examples of research areas and questions that could advance 
scientific knowledge about implementation and deployment.  The list is not 
exhaustive, and it is expected that additional important research topics may be 
identified by those who respond to the announcement.  Studies in these areas can 
include, but are not limited to:

o  Studies of the structure or organization of practice environments that 
facilitate or impede diffusion of preventive programs within different settings 

o  Studies of aspects of the organizational culture or climate that affect 
motivational, attitudinal, or skills of direct care providers and which may be 
associated with the uptake and sustainability of preventive strategies into 
different environments

o  Studies of the cost effectiveness of preventive strategies when implemented 
in different settings

o  Studies of models for facilitating collaboration among service professionals 
that lead to sustainability of preventive strategies

o  Replication studies of established preventive strategies within ethnically-
diverse communities, with attention to the tailoring of such programs to reflect 
cultural differences

o  Research on community-level or environmental variables that impede or 
strengthen training programs aimed at ensuring fidelity to implementation of 
research-based preventive approaches

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).  It is also NIH 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 Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research," which was published in the Federal Register of March 28, 1994 (FR 59 
14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No. 11, 
March 18, 1994, available on the web at:
http://grants.nih.gov/grants/guide/notice-files/not94-100.html

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 should 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: http://grants.nih.gov/grants/guide/notice-files/not98-024.html

Investigators also may obtain copies of the policy from the program staff listed 
under INQUIRIES.  Program staff may also provide additional relevant information 
concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit 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 the 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 Institute staff to estimate 
the potential review workload and avoid conflict of interest in the review.

The letter of intent is to be sent to Dr. Kimberly Hoagwood, listed under 
INQUIRIES, by May 15, 2000.

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 4/98) is to be used in 
applying 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) 435-0714, Email: 
GrantsInfo@nih.gov.  The application is also available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html

SPECIFIC APPLICATION INSTRUCTIONS FOR MODULAR GRANTS

The modular grant concept establishes specific modules in which direct costs may 
be requested as well as a maximum level for requested budgets. Only limited 
budgetary information is required under this approach.  The just-in-time concept 
allows applicants to submit certain information only when there is a possibility 
for an award.  It is anticipated that these changes will reduce the 
administrative burden for the applicants, reviewers and Institute staff.  The 
research grant application form PHS 398 (rev. 4/98) is to be used in applying 
for these grants, with the modifications noted below.

BUDGET INSTRUCTIONS

Modular Grant applications  will request direct costs in $25,000 modules, up to 
a total direct cost request of $250,000 per year.  (Applications that request 
more than $250,000 direct costs in any year must follow the traditional PHS 398 
application instructions.)  The total direct costs must be requested  in 
accordance with the  program guidelines and the modifications made to the 
standard  PHS 398 application  instructions described below:

PHS 398

o  FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total 
Direct plus Facilities and Administrative  (F&A) costs] for the initial budget 
period Items 8a and 8b should be completed indicating the Direct and Total Costs 
for the entire proposed period of support.

o  DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD - Do not complete Form Page 4 
of the PHS 398.  It is not required and will not be accepted with the 
application.

o  BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT - Do not complete the 
categorical budget table on Form Page 5 of the PHS 398.  It is not required and 
will not be accepted with the application.

o  NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page. (See http://grants.nih.gov/grants/funding/modular/modular.htm for sample 
pages.) At the top of the page, enter the total direct costs requested for each 
year.  This is not a Form page.

o  Under Personnel, List key project personnel, including their names, percent 
of effort, and roles on the project.  No individual salary information should be 
provided.  However, the applicant should use the NIH appropriation language 
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the nearest 
$1,000.  List the individuals/organizations with whom consortium or contractual 
arrangements have been made, the percent effort of key personnel, and the role 
on the project.  Indicate whether the collaborating institution is foreign or 
domestic.  The total cost for a consortium/contractual arrangement is included 
in the overall requested modular direct cost amount.  Include the Letter of 
Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o  BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by  
reviewers in the assessment of each individual's qualifications for a specific 
role in the proposed project, as well as to evaluate the overall qualifications 
of the research team.  A biographical sketch is required for all key personnel, 
following the instructions below.  No more than three pages may be used for each 
person.  A sample biographical sketch may be viewed at:  
http://grants.nih.gov/grants/funding/modular/modular.htm 

- Complete the educational block at the top of the form page;
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on research 
projects ongoing or completed during the last three years.
- List selected peer-reviewed publications, with full citations;

o  CHECKLIST - This page should be completed and submitted with the application.  
If the F&A rate agreement has been established, indicate the type of agreement 
and the date.  All appropriate exclusions must be applied  in the calculation of 
the F&A costs for the initial budget period and all future budget years.

o  The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information is 
necessary following the initial review.

The RFA label available in the PHS 398 (rev. 4/98) application form must be 
affixed to the bottom of the face page of the application and must display the 
RFA number MH-00-011. A sample modified mailing label is available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.  Please note this is 
in pdf format.  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, Implementation of Intervention 
Strategies for Children with Disruptive Disorders, MH-00-011, must be typed on 
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 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 be sent 
to:

Henry Haigler, Ph.D.
National Institute of Mental Health
6001 Executive Boulevard, Room 6154, MSC 9609
Bethesda, MD 20892

Applications must be received by June 13, 2000.  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 the NIMH staff.  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 
NIMH in accordance with the review criteria stated below.  As part of the 
initial merit review, a process will be used by the initial review group in 
which applications receive a written critique and undergo a process in which 
only those applications deemed to have the highest scientific merit, generally 
the top half of the applications under review, will be discussed, assigned a 
priority score, and receive a second level review by the National Advisory 
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.  Note that the 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, an investigator 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 this study address an important problem?  If the aims of 
the application are achieved, how will scientific knowledge be advanced?  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?  Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or methods?  
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator:  Is the investigator appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to the experience level 
of the principal investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the 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?

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.

Schedule

Letter of Intent Receipt Date:  May 15, 2000
Application Receipt Date: June 13, 2000
Peer Review Date:  August 2000
Council Review: September 2000
Earliest Anticipated Start Date: September 29, 2000

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.

Direct inquiries regarding implementation, deployment, and cost-effectiveness 
to:

Kimberly Hoagwood, Ph.D. 
Services Research Branch
Division of Services and Intervention Research
6001 Executive Boulevard
Bethesda, MD  20892
Telephone:  301-443-3364
FAX:  301-443-4045
Email:  khoagwoo@nih.gov

Direct inquiries regarding new intervention development to:

Farris Tuma, Sc.D.
Developmental Psychopathology and Prevention Research Branch
6001 Executive Boulevard, Room 6200, MSC 9617
Bethesda, MD 20892
Telephone:  (301) 443-9232
FAX:  301-480-4415
Email: ftuma@nih.gov

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD 20892-9605
Telephone: (301) 443-2805
FAX:  (301) 443-6885
Email:  Diana_Trunnell@nih.gov

The National Center for Injury Prevention and Control (NCIPC) of CDC expects to 
announce availability of funds in March of 2000 to support Academic Centers of 
Excellence in the area of Youth Violence Prevention. The intent of these Centers 
will be, in part, to provide infrastructure for conducting program development 
and intervention oriented research. Information about the request for proposals 
is expected to be available on the NCIPC internet site 
(<http://www.cdc.gov/ncipc/ncipchm.htm>) in February.

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No. 
93.242 (NIMH).  Awards are made under authorization of the Public Health Service 
5600 Fishers Lane Act, Title IV, Part A (Public Law 78-410, as amended by Public 
Law 99-158, 42 USC 241 and 285) and administered under NIH grants policies and 
Federal Regulations 42 CFR 52 and 45 CFR Part 74.  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 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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