PA-00-032: POPULATION MOVEMENT: DETERMINANTS AND CONSEQUENCES

Department of Health
and Human Services (HHS)

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POPULATION MOVEMENT: DETERMINANTS AND CONSEQUENCES Release Date: December 22, 1999 PA NUMBER: PA-00-032 National Institute of Child Health and Human Development National Institute on Aging THIS PA USES THE "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. IT INCLUDES DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS PA. PURPOSE The Demographic and Behavioral Sciences Branch (DBSB), Center for Population Research, National Institute of Child Health and Human Development (NICHD), and the Demography and Population Epidemiology Branch, Behavioral and Social Research Program, National Institute on Aging (NIA), invite qualified researchers to submit applications for research on the determinants and consequences of population movement. The "determinants" of migration include characteristics of places and sociopolitical units, and of persons and their families. The "consequences" of migration refer to the relative performance of migrants in their new location, the effects of migration on origin and destination populations, and the impact of migrants on population structure, density, crowding, and environmental outcomes. The potential contribution of demographic research and methods to understanding individual and social outcomes extends broadly across the spheres of health, human development, aging, retirement, family, and material well-being. Research on population movement encompasses studies of migration within national boundaries (internal migration) as well as movement across borders (international migration). This announcement highlights topics especially salient to the former, but encompasses research on all forms of population movement. For a fuller treatment of issues related to international migration, potential applicants are encouraged to review an earlier announcement that gives fuller treatment to immigration (PA-95-035, Research on U.S. Immigration). 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 Program Announcement (PA) is related to one or more of the priority areas. Potential applicants may obtain "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 PA will use the National Institutes of Health (NIH) research project grant (R01) award mechanism. 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 PA may not exceed five years. For all research project grant (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 examined by NIH. Complete and detailed instructions and information on Modular Grant applications can be found 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. RESEARCH OBJECTIVES Background Migration has been an important part of human experience throughout our history, and these migration flows continue to play an important role in shaping the populations of cities, states, and regions. Migration is associated with family formation and unification, retirement, and changes in health status. In the United States, over 40 million people, or about 17 percent of the total population, change residence in a year. One of the most universal mobility relationships is that between age and migration. Migration propensities peak during the early to mid-twenties and then decline steadily, with an upturn at retirement age in some countries. In the U.S., working age adults and children are the most mobile, although the majority of their moves occur within the same county. There is considerable geographic mobility among certain segments of the U.S. population, such as single mothers, retirees, and workers in certain occupations and industries. Internal migration is a particularly under-researched, crosscutting area that is likely to gain increasing importance in the future. Internal migration refers to population movement within a country, such as that between regions (e.g., North to South, East to West), between states, between urban and rural areas, between urban and suburban areas, and/or between poor and non-poor neighborhoods. Internal migration patterns also differ depending on whether migrants are native-born, and are likely to be influenced by the spatial structure and levels of immigration flows. For example, high international immigration to a metropolitan area is associated with increased internal out-migration and reduced internal in-migration among less-educated native-born residents, within race-ethnic gender groups. Internal population movements may be affected by the devolution of responsibilities for social programs to the states. This may magnify cross- area differences and stimulate more frequent changes in social programs and amenities, and could increase the mobility of the population as people sort themselves across localities in order to receive benefits or avoid program restrictions. The relationships among social programs, tax structures, and other policies that vary significantly across states have particular importance to retirees, who are no longer geographically limited by their employment. Research is needed to better understand the relocation decisions of retirees, their relationship to social programs and tax policies, and other factors. The ability to assess the impacts of such programs and policies will depend on attention to population movement. There has been much attention to neighborhood and school effects in recent years, but clearly who one"s neighbors are or what schools one"s children attend depend critically on the choice (or lack of choice) of place of residence. Among the issues needing attention are the relationship between geographic and economic mobility, effects of migration on the well-being and development of children, barriers to mobility, the influence of family considerations on mobility, and the interrelationships between migration and health. There is, thus, an important need to better understand the circumstances surrounding, motivations behind, and consequences of population movement and settlement. The following areas describe more fully examples of areas of interest addressed by this PA. Applications need not be limited to these topics, nor must they encompass all of these issues. Research Scope o Prior research to understand reasons for population movement has focused on push factors (e.g., deepening poverty, political instability, environmental degradation) and pull factors (e.g., better jobs, lower taxes, better health care, better climate). A challenge is to integrate individual and household models in the broader social and political context. Although economic motives account for a substantial proportion of moves, consideration also must be given to distinguishing mobility decisions (both timing and place) and motivations by distance, frequency and duration of moves, and cohort size. Research also must link migration with business cycles, and consider the important role of social networks, e.g., prior links between sending and receiving areas based on familial and/or cultural ties, political influence, trade, and investment. Consideration also must be given to understanding individual-level analyses in the broader institutional context (e.g., political economy, inter-state relationships, legal frameworks). o Research has examined the characteristics of people who move. Specifically, research has focused on selectivity of migrants by age, industry, and education, as well as personality characteristics such as propensities for risk-taking and adaptability. Less well studied, but no less universal, is the strong positive correlation between educational attainment and the likelihood of moving from cities to suburbs, or from poor neighborhoods to non-poor neighborhoods. Equally important is to understand the causes for non-mobility, and the associated spatial concentration of poverty and wealth in American urban areas. o Innovative, theory-driven research on migration is needed to improve modeling of selection effects, and to understand the paths and barriers to residential mobility by specific subpopulations (e.g., welfare recipients, single mothers, children, elderly, immigrants). Better insights are needed to explain differences in propensities to migrate by race/ethnicity, or by stages of family formation, particularly out of poor neighborhoods. o Health status is an important indicator of many aspects of the migration process, reflecting, to some degree, differential selectivity and assimilation of migrants, as well as the impact of population density and crowding. Further research is needed on migrant selectivity with respect to health, the relationship between health changes and migration, including the impact of migration on health and access to health services, and the use of alternative assisted living arrangements. For example, disability or illness in a child or other family member may prompt migration to improve access to health services or family resources, or prevent a move that might otherwise occur. o Little is known about how declining disability rates seen in the 1980s and 1990s among the elderly and how caregiving needs (of parents or children) may encourage or discourage migration. To what extent does geographic dispersion of family members influence rates of institutionalization of the elderly? To what extent do patterns of household moves (including intra-metropolitan household moves) change to accommodate changes in functional ability, including moves into assisted living environments and nursing homes? How has the rise of alternative assisted living arrangements and the changing geographic distribution of health care organizations, including hospitals, influenced elderly mobility rates, particularly where proximity to health services is an important consideration? o Further research is needed on the interrelationships of demographic processes (fertility, mortality, formation and dissolution of marriages and marriage-like relationships) and migration. Moves may be precipitated by divorce or death, the impending birth of a child, or entry into a new stage of the family life cycle (school-age children or empty nest). What is the impact of changing family structure, including the increase in divorce rates, nonmarital childbearing, and ratios of step- to biological children on migration? Alternatively, migration may have an influence on the timing and volume of fertility, and on subsequent health and well-being. o Since movement from rural to urban areas is often a useful way to describe internal migration patterns, it is important to recognize health problems associated with urbanization as an important consequence of migration. The urban environment can be particularly hostile to children. Although studies have linked urbanization with mental health outcomes (e.g., depression and anxiety, schizophrenia, and alcohol and substance abuse), research needs to go beyond the standard age/sex/social class studies associated with mental illness, and needs to elaborate on the mechanisms by which these factors operate, being careful to tease out effects due specifically to urbanization, and effects due to selectivity of particular migrant streams. o Urbanization is associated with higher concentrations of people, increasing the potential for the spread of pathogens. High density of populations can exacerbate transmission, particularly if sewage and water systems, housing, and public health provisions are inadequate. Research needs to reference explicitly the interactions between mobility and infectious disease transmission-- a key issue in HIV spread. Little is known empirically about the geographic pattern and span of networks that spread diseases. o Rural to urban and urban to suburban migration may have other important effects on the sending and receiving communities. Sending areas may lose population, changing the population age structure and threatening economic viability. Encroaching suburbanization may create environmental and economic challenges for existing populations. Research is needed on the mechanisms that influence the adaptation of rural communities and their inhabitants to migratory patterns. o It has become increasingly clear that moving and timing of moves may affect children in important ways, presumably because of changes in school and peer group. In general, these effects have not been estimated well. For parents, one of the ways to change the environment in which the child is growing up, and one of the few ways to have an impact on the child"s peer group, is to move. Research is needed to study parental decisions to move and the impact of moves on a variety of child outcomes. o Studies of contextual influences at the school or community level must account for the fact that families often choose these contexts for themselves and their children. Strategies must be developed to model such mobility- related selection effects in contextual and multi-level research. o Defederalizing public benefits could lead to substantial variation among the states in program benefits and eligibility requirements. It is opportune to study the consequent or anticipatory movement of people in response to welfare program developments and the impact of moves on states and local communities. One could broaden the perspective toward a set of environmental issues involving location and housing. The effects of other public policies, such as school choice proposals, on migration decisions may also merit study. o Many states have tax advantages that are targeted toward retirees, such as tax exemptions for pension income. States also have different eligibility criteria for programs that provide benefits to older residents. Traditional retirement destinations, most notably those in southern and southwestern states, appear to attract populations self-selected for higher income, better health, and strong social supports. The demand for public services actually may be lower and net economic benefits higher. As these migrants age, however, pressures on community resources (e.g., public transportation, emergency medical services, home care, long term care, and perhaps income support) may be expected to rise. Research is encouraged on how varying state policies influence relocation decisions in retirement, and on factors influencing "reverse migration." Research is also encouraged on the economic consequences for states (both costs and benefits) of in- or out-migration among retirees. o Recent changes in Federal tax policy with respect to capital gains on the sale of a primary residence are likely to induce homeowners to relocate or buy-down. To what extent can Federal tax policies explain changes in migration propensities, particularly among the elderly? o Swings in national economic conditions also help shape the propensity to migrate, and the characteristics of migrants. Migrants tend to be self- selected in that they typically possess greater motivation to improve their situation. Since lower costs are associated with migration during periods of relatively good economic conditions, the average migrant during those times may be expected to be of lower socioeconomic status. Tracking changing characteristics of migrants in relation to macro-economic conditions should be considered to address such issues. o Patterns of "continuation migration" and "reverse migration," and the relation of socioeconomic status and other demographic characteristics to choice of destination are also important areas of study. For example, how are retirement migration patterns influenced by changing wealth levels and consumption patterns, as well as the rise of dual wage earner households? How are regional trends in employment opportunities related to migration streams for households at different economic levels? o The U.S. stands out as having high population movement between local areas and within local areas. Yet in other developed countries (e.g., Canada, Germany, Japan, Netherlands), internal migration rates have fallen during the past 25 years. A rigorous comparison of patterns across countries could help us better understand (and perhaps quantify) the contribution of factors such as later age at marriage, increasing female labor force participation, economic opportunities, and cohort and period effects. o Migration within and across national boundaries in the developing world also merits study. For example, what is the impact of cross-national migration (e.g., between the U.S. and Mexico) on dependent family members (e.g., elderly, children)? Many of the topics highlighted above are applicable across the globe, additional issues relating to developing world migration include the interrelationships among environmental quality, urbanization, economic development, health, capital investments, and international migration flows. o New methodological approaches for the study of migration are needed, including better ways to collect and analyze data to describe and explain migration patterns and trends, and indirect estimation of migration streams. Data collection strategies are needed that go beyond the traditional sample surveys of individual respondents to also capture broader aspects of the social and biophysical context. Innovative and useful linkage of migration and population distribution data with spatial data should be considered. To the extent that geographic context variables appear to be important, retrospective residence histories should be included. More methodological work is needed on how best to collect retrospective histories that can then be linked to geographic indices, making it possible to model the internal migration process. Geocoding migration histories also could inform our understanding of the relationship between the geographical distribution of disease and environment-related conditions over time. It is also important to model adjacent area characteristics (e.g., proximity to large cities) in migration decisions. Many data sources - continuing national surveys such as the Current Population Survey (CPS), U.S. Census, National Longitudinal Survey of Youth (NLSY), and the Panel Study of Income Dynamics (PSID), and ad hoc studies at the state and local levels - may be drawn upon. Baseline data from the NIA- funded Health and Retirement Study includes a 100 percent oversample of the state of Florida and is likely to be especially helpful to understanding these influences on elderly migration. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification are 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). All investigators proposing research involving human subjects should read the "NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research," that was 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, and are available on the Internet 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 on the Internet at http://grants.nih.gov/grants/guide/notice-files/not98-024.html. Investigators also may obtain copies of these policies from the program staff listed under INQUIRIES. Program staff also may provide additional relevant information concerning the policy. APPLICATION PROCEDURES Applications are to be submitted on grant application form PHS 398 (rev. 4/98) and will be accepted at the standard application deadlines, as indicated in the application kit. Application kits are available at most institutional offices of sponsored research and may be obtained 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, E-mail [email protected]. Application forms also are available on the Internet at http://grants.nih.gov/grants/funding/phs398/phs398.html . Applicants planning to submit an investigator-initiated new (Type 1), competing continuation (Type 2), competing supplement, or any amended/revised version of the preceding grant application types requesting $500,000 or more in direct costs for any year are advised that they must contact NICHD or NIA program staff before submitting the application, i.e., as plans for the study are being developed. Furthermore, applicants must obtain agreement from NICHD or NIA staff that the Institute will accept the application for consideration for award. Finally, applicants must identify, in a cover letter sent with the application, the staff member and Institute who agreed to accept assignment of the application. This policy requires applicants to obtain prior agreement for acceptance of both any such application and any such subsequent amendment. Refer to the NIH Guide for Grants and Contracts, March 20, 1998, at http://grants.nih.gov/grants/guide/notice-files/not98-030.html. Application Instructions 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. 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: 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. 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 F&A) 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. Submission Instructions The title and number of this program announcement 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 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) REVIEW CONSIDERATIONS Applications will be assigned on the basis of established PHS referral guidelines. Applications that are complete will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with the standard NIH peer review procedures. As part of the initial merit review, all applications will 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 applications under review, will be discussed, assigned a priority score, and 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 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. AWARD CRITERIA Applications will compete for available funds with all other scored applications. The following will be considered in making funding decisions: o Quality of the proposed project as determined by peer review, o Availability of funds, o Program priority. INQUIRIES Inquiries concerning this PA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Christine A. Bachrach, Ph.D. Demographic and Behavioral Sciences Branch Center for Population Research National Institute of Child Health and Human Development 6100 Executive Boulevard, Suite 8B07, MSC 7510 Bethesda, MD 20892-7510 Telephone: (301) 496-9485 FAX: (301) 496-0962 E-mail: [email protected] (e-mail correspondence is preferred) Rose Maria Li, M.B.A., Ph.D. Demography and Population Epidemiology Behavioral and Social Research Program National Institute on Aging 7201 Wisconsin Avenue, Suite 533, MSC 9205 Bethesda, MD 20892-9205 Telephone: (301) 496-3138 FAX: (301) 402-0051 E-mail: [email protected] (e-mail correspondence is preferred) Direct inquiries regarding fiscal matters to: Michael J. Loewe Grants Management Branch National Institute of Child Health and Human Development 6100 Executive Boulevard, Suite 8A17, MSC 7510 Bethesda, MD 20892-7510 Telephone: (301) 435-7008 FAX: (301) 402-0915 Email: [email protected] David Reiter Grants and Contracts Management Office National Institute on Aging 7201 Wisconsin Avenue, Suite 2N212, MSC 9205 Bethesda, MD 20892-9205 Telephone: (301) 496-1472 FAX: (301) 402-3672 Email: [email protected] (e-mail correspondence is preferred) AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Nos. 93.866 and 93.864. Awards are made under authorization of the Public Health Service 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 Parts 74 and 92. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, 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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